Robotic surgical table with relatively high resonant frequency structure to reduce efficiency of energy transmission between attached robotic arms

ABSTRACT

Apparatus and methods for providing a surgical table base with sufficient stiffness and adjustable support members with force feedback are described herein. In some embodiments, a base for a surgical table includes a base body to which other components of a surgical table can be coupled. A surgical table, and optionally a patient supportable by the surgical table, and any equipment to be carried by the surgical table, collectively representing a table load to be carried by the base body to support the surgical table on a surface. The base further includes a support assembly coupled to the base body to support the base body on the surface. The support assembly includes at least four support members. Each support member has a surface-engaging end and can transmit a portion of a total load represented by the weight of the base and the table load through the surface-engaging end to the surface. The surface-engaging ends of any three of the four support members define a plane. One of the support members is adjustable to move the one support member relative to a plane defined by the three of the other support members and thereby to change the portion of the total load carried by one of the support members. The base further includes a load sensor operably coupled to the support assembly and disposed to detect the portion of the total load carried by one of the support members.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to and benefit of U.S. ProvisionalPatent Application No. 62/426,966, entitled “Surgical Table Base withHigh Stiffness and Adjustable Support Members with Force Feedback,”filed Nov. 28, 2016; U.S. Provisional Patent Application No. 62/443,393,entitled “Robotic Surgical Table with Relatively High Resonant FrequencyStructure to Reduce Efficiency of Energy Transmission Between AttachedRobotic Arms,” filed Jan. 6, 2017; and U.S. Provisional PatentApplication No. 62/483,060, entitled “Robotic Surgical Table Adapter toReduce Efficiency of Energy Transmission Between Attached Robotic Arms,”filed Apr. 7, 2017; the disclosures of each of which are incorporatedherein by reference in their entirety.

BACKGROUND

Some embodiments described herein relate to apparatus and methods for abase for a surgical table having four or more support members to supportthe base stably on a surface. Further embodiments described hereinrelate to surgical tables with robotic surgical arms, and apparatus andmethods for reducing unwanted vibration at the working ends of therobotic arms. Yet further embodiments described herein relate toadapters for surgical tables with robotic surgical arms, and apparatusand methods for reducing unwanted vibration at the working ends of therobotic arms.

Stability of surgical tables during surgery is important to their safeand effective clinical use. Certain design characteristics improve thestability of surgical tables, such as a rigid support structure. Inaddition, it is also desirable for surgical tables to allow adjustmentof patient position in one or more axes of motion, and to allow forwheeled transport around the hospital. The most common design ofsurgical tables is to have a large base sufficiently sized to preventtipping, containing wheels, and having a means of locking to the floorto enhance stability.

One conflicting requirement with stability is dealing with floorirregularities. The problem is that to achieve stability, both inrigidity, as well as tipping, the base must be as large as possible.However, the base is also limited to a size that enables clinicalaccess, which means that it must have a footprint no larger than thefootprint of the table top. Thus, bases typically have a generallyrectangular shape, and have four points of contact with the floorinstead of the three needed for kinematic constraint.

Some surgical tables are mobile, can be wheeled around, and arefrequently swapped in and out of an operating room based on the type ofsurgical procedure being performed. Such movement of the surgical tableswithin the operating room requires dealing with irregularities in thefloor surface (e.g., variations in elevation of the floor surface).Given irregularities, such as drains, craftsmanship defects, bubbling,delamination of flooring, even dirt and grime, a rigid base with fourpoints of contact may result in only three points in contact, and one inthe air. This creates a situation where the table can rock back andforth, as is commonly observed in restaurant tables. Instability duringsurgery could cause irritation to surgeons and assistants at the veryleast or even a dangerous surgical situation. Thus, a solution is neededwhere the table is not only structurally rigid, but also mobile, andable to tolerate irregularities in the floor.

Further, robotic surgical systems can include robotic surgical arms thatare coupled, directly or indirectly (e.g., via an adapter), to asurgical table on which a patient can be supported during a surgicalprocedure. The robotic surgical arms may support at their distal,working ends various devices, including surgical instruments, cannulaefor providing access to the patient's body cavity(ies) and organ(s) forapplication of surgical instruments, imaging devices, lights, etc. Insuch systems, it is desirable to establish and maintain high positionalaccuracy for the devices mounted on the distal ends of the robotic arms.

Positional accuracy can be reduced or degraded by vibration of thedistal ends of the robotic arms. Such vibration may be in the form ofvibrational cross-talk, which is unwanted vibration occurring in onepart of the system that originates in another part of the system. Forexample, vibration may be induced within a robotic arm, such as byoperation of a motor driving movement of some portion of the armrelative to another portion of the arm and/or to the surgical table orother supporting structure, and the energy introduced into the arm byoperation of the motor may propagate through the arm to the distal end,inducing vibration in the distal end. This arm may be referred to as the“active” arm. Alternatively, or additionally, energy introduced into theactive arm, such as by operation of a motor within the active arm, maypropagate through the active arm, through the table or other supportingstructure, and through another robotic arm (which may be referred to asthe “passive” arm) to the passive arm's distal end.

It is desirable to reduce vibrational cross-talk to enhance positionalaccuracy of the distal ends of robotic arms and the devices attachedthereto.

SUMMARY

Apparatus and methods for providing a surgical table base withsufficient stiffness and adjustable support members with force feedbackare described herein. In some embodiments, a base for a surgical tableincludes a base body having a lower side and an upper side to whichother components of a surgical table can be coupled. A surgical table,and optionally a patient supportable by the surgical table, and anyequipment to be carried by the surgical table, collectively represent atable load to be carried by the base body to support the surgical tableon a surface. The base further optionally includes wheels, and includesa support assembly coupled to the base body to support the base body onthe surface. A mechanism in a base having wheels allows switching thetable from a mobile configuration to a fixed configuration bytransferring load from the wheels to the support assembly. The supportassembly includes at least four support members spaced about the basebody. Each support member has a surface-engaging end and can transmit aportion of a total load represented by the weight of the base and thetable load through the surface-engaged end to the surface. Thesurface-engaging ends of any three of the four support members define aplane. One of the support members is adjustable to move thesurface-engaging end of the one support member relative to a planedefined by the surface-engaging ends of three of the other supportmembers and thereby to change the portion of the total load carried byone of the support members. The base further includes a load sensoroperably coupled to the support assembly and disposed to detect theportion of the total load carried by one of the support members.

Apparatus and methods for providing a pivotable surgical table withrobotic surgical arms, having sufficient stiffness to limit unwantedvibration at the working ends of the robotic arms, are described herein.In some embodiments, a surgical table includes a base, a support columnextending upwardly from the base and having an upper end, a table top,and a pivot assembly coupling the table top to the upper end of thesupport column. The pivot assembly includes a support flange attached tothe upper end of the support column and has portions distributed aboutthe support column. The pivot assembly further includes a primary loadsupport, a first actuator and a second actuator. The primary loadsupport has a lower end coupled to the support flange and an upper endhaving a pivotable coupling to the table top. The first actuator has alower end coupled to the support flange at a first portion of the flangedisposed on a first side of the support column and an upper end having apivotable coupling to the table top. The first actuator is variable inlength to pivot the table top about the pivotable coupling of theprimary load support about a first pivot axis. The second actuator has alower end coupled to the support flange at a second portion of theflange disposed on a second side of the support column opposite to thefirst side and an upper end having a pivotable coupling to the tabletop. The second actuator is variable in length to pivot the table topabout the pivotable coupling of the primary load support about a secondpivot axis different from the first pivot axis.

Apparatus and methods for providing an adapter coupleable to, andsupportable by, a surgical table below a tabletop of the surgical table.The surgical table has a support coupled to the tabletop and a basecoupled to the support. The adapter has a first section configured to becoupled to a proximal end portion of a first robotic arm and a secondsection configured to be coupled to a proximal end portion of a secondrobotic arm. The first section has a first stiffness and the secondsection has a second stiffness that is greater than the first stiffness.A distal end portion of the first robotic arm is coupleable to a firstsurgical tool and a distal end portion of the second robotic arm iscoupleable to a second surgical tool.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B are schematic side and top views, respectively, of asurgical table, according to an embodiment.

FIGS. 2A and 2B are schematic bottom and side views, respectively, ofthe base of the surgical table of FIGS. 1A and 1B.

FIGS. 2C and 2D are schematic illustrations of a base for a table havingthree and four, respectively, support members.

FIG. 3A is a schematic side view of the base of FIGS. 2A, 2B,illustrating the surface-engaging ends of three of the support membersdefining a plane and the surface-engaging end of the fourth supportmember movable relative to the plane.

FIG. 3B is a schematic side view of the base of FIGS. 2A, 2B,illustrating the surface-engaging ends of three of the support memberscontacting a support surface that has an irregularity; and thesurface-engaging end of the fourth support member movable relative tothe irregularity.

FIGS. 4A and 4B are schematic side and top views, respectively, of thebase of FIGS. 2A, 2B, illustrating the distribution of the total loadamong the supporting members.

FIG. 5 is a schematic illustration of an adjustable support memberaccording to an embodiment.

FIG. 6 is a schematic illustration of a controller of the surgical tableof FIGS. 1A and 1B.

FIGS. 7A and 7B are schematic bottom and side views, respectively, of abase of a surgical table, according to an embodiment.

FIG. 8 is a flow chart illustrating a method according to an embodiment.

FIGS. 9A and 9B are schematic side and top views, respectively, of asurgical table, according to an embodiment.

FIGS. 9C and 9D are a schematic side view and a schematic top view,respectively, of the surgical table of FIGS. 9A and 9B with robotic armscoupled thereto.

FIG. 10A is a schematic side view of a robotic arm, according to anembodiment, shown in an extended or use configuration; and FIG. 10B is aschematic side view of the robotic arm of FIG. 10A, shown in a collapsedor folded configuration.

FIGS. 11A and 11B are a schematic side view and a schematic top view,respectively, of the surgical table of FIGS. 9A and 9B with an adapterand robotic arm coupled thereto.

FIG. 12A is a schematic side view of an adapter, according to anembodiment, shown in an extended or use configuration; and FIG. 12B is aschematic side view of the adapter of FIG. 12A, shown in a collapsed orfolded configuration.

FIG. 13 is a schematic illustration of a top view of a portion of thesurgical table; adapter and robotic arm of FIGS. 9A-11B, illustratingdegrees of freedom associated with the joints of the adapter.

FIG. 14 is a schematic illustration of a top view of a portion of thesurgical table, adapter and robotic arm of FIGS. 9A-11B, illustratinginduced unwanted vibrational transmissions.

FIGS. 15A and 15B are schematic side and front views, respectively, ofthe surgical table of FIGS. 9A-11B, illustrating undesirable sway of thetable top relative to the base.

FIGS. 16A and 16B are schematic side and front views, respectively, ofthe surgical table of FIGS. 9A-11B, illustrating pivotal movement of thetable top relative to the base.

FIGS. 17A-17C are schematic side, cross-sectional top, and front views,respectively, of a surgical table having a pivot assembly coupled abouta column, according to an embodiment.

FIGS. 18A-18C are schematic side, cross-sectional top, and front views,respectively, of a surgical table having a pivot assembly coupled abouta column, according to an embodiment.

FIG. 18D is a cross-sectional top view of an alternative configurationof the pivot assembly of FIGS. 18A-18C.

FIGS. 19A-19C are schematic side, cross-sectional top, and front views,respectively, of a surgical table having a pivot assembly coupled to acolumn, according to an embodiment.

FIG. 19D is a schematic cross-sectional view of an alternative supportstructure for the pivot assembly of FIGS. 19A-19C.

FIG. 19E is a cross-sectional top view of an alternative configurationof the pivot assembly of FIGS. 19A-19C.

FIG. 20A is a schematic side view of a surgical table having a pivotassembly coupled to a column, robotic arms coupled to a table topadapter, and a table top in a first orientation, and FIG. 20B is aschematic side view of the surgical table of FIG. 20A in a secondorientation, according to an embodiment.

FIG. 21A is a schematic side view of a surgical table having a pivotassembly coupled to a support flange, robotic arms coupled to thesupport flange, a table top in a first orientation, according to anembodiment. FIG. 21B is a schematic cross-sectional top view of FIG.21A. FIG. 21C is a schematic side view of the surgical table of FIG. 21Ain a second orientation.

FIGS. 21D and 21E are schematic front and top views of an alternativeconfiguration of the surgical table of FIGS. 21A-21C.

FIGS. 22A and 22B are schematic side and front views, respectfully, of asurgical table having support struts, according to an embodiment.

FIG. 23A is a schematic cross-sectional side view of the support strutof FIGS. 22A and 22B, in a first configuration, and FIG. 23B is aschematic cross-sectional side view of the support strut of FIGS. 22Aand 22B in a second configuration.

FIGS. 24A and 24B are schematic side and top views, respectively, of asurgical table, according to an embodiment.

FIGS. 24C and 24D are a schematic side view and a schematic top view,respectively, of the surgical table of FIGS. 24A and 24B with roboticarms coupled thereto.

FIG. 25A is a schematic side view of a robotic arm, according to anembodiment, shown in an extended or use configuration; and FIG. 25B is aschematic side view of the robotic arm of FIG. 25A, shown in a collapsedor folded configuration.

FIG. 26 is a schematic illustration of a top view of a portion of thesurgical table, adapter and robotic arm of FIGS. 24A-25B, illustratinginduced unwanted vibrational transmissions.

FIGS. 27A and 27B are schematic top and side views, respectively, of anadapter for a surgical table having a first section with a firstthickness and a second section with a second thickness different fromthe first thickness, according to an embodiment.

FIG. 27C is a schematic side view of an adapter for a surgical tablehaving a first section and a second section that share a monolithicmaterial, and an additional piece of material added to the firstsection.

FIGS. 27D and 27E are schematic side and front views, respectively, ofan adapter for a surgical table having a first section including a setof ribs.

FIGS. 28A and 28B are schematic top and side views, respectively, of anadapter for a surgical table, according to another embodiment.

FIGS. 29A-29C are schematic top, side, and front views, respectively, ofan adapter for a surgical table having a damping component, according toan embodiment.

FIGS. 30A and 30B are schematic top and side views, respectively, of anadapter for a surgical table having a damper assembly, according to anembodiment.

DETAILED DESCRIPTION

Apparatus and methods for providing a surgical table base withsufficient stiffness and adjustable support members with force feedbackare described herein with respect to FIGS. 1A-8 . In some embodiments, abase for a surgical table includes a base body having a lower side andan upper side to which other components of a surgical table can becoupled. A surgical table, and optionally a patient supportable by thesurgical table, and any equipment to be carried by the surgical table,collectively represent a table load to be carried by the base body tosupport the surgical table on a surface. The base further includes asupport assembly coupled to the base body to support the base body onthe surface. The support assembly includes at least four support membersspaced about the base body. Each support member has a surface-engagingend and can transmit a portion of a total load represented by the weightof the base and the table load through the surface-engaged end to thesurface. The surface-engaging ends of any three of the four supportmembers define a plane. One of the support members is adjustable to movethe surface-engaging end of the one support member relative to a planedefined by the surface-engaging ends of three of the other supportmembers and thereby to change the portion of the total load carried byone of the support members. The base further includes a load sensoroperably coupled to the support assembly and disposed to detect theportion of the total load carried by one of the support members.

In some embodiments, a method includes stabilizing a surgical table on asurface. The surgical table has a base. The surgical table andoptionally a patient supportable by the surgical table, and anyequipment carried by the surgical table collectively representing atotal load supported on the surface. The base includes a supportassembly. The support assembly includes at least four support membersspaced about the base. Each support member has a surface-engaging endand can transmit a portion of the total load through thesurface-engaging end to the surface. One of the support members isadjustable to move the surface-engaging end of the one support member.The base further includes a load sensor disposed to detect the portionof the total load carried by one of the support members. The methodincludes receiving a signal from the load sensor indicative of theportion of the total load carried by the one of the support members, anddetermining whether the portion of the total load is not within anacceptable range. The method further includes, if the portion of thetotal load is not within the acceptable range, causing thesurface-engaging end of the adjustable support member to move relativeto a plane defined by the surface-engaging ends of three of the othersupport members and thereby to change the portion of the total loadcarried by one of the support members. In some embodiments,stabilization may occur when at least a portion of the load is beingtransferred from the wheels to the support members to transition thetable from a mobile to a fixed configuration. In other embodiments,stabilization may occur any time the support members are carrying atleast a portion of the load of the table.

As used herein, the singular forms “a,” “an”, and “the” include pluralreferents unless the context clearly dictates otherwise. Thus, forexample, the term “a member” is intended to mean a single member or acombination of members, “a material” is intended to mean one or morematerials, or a combination thereof.

As used herein, a “set” can refer to multiple features or a singularfeature with multiple parts. For example, when referring to a set ofribs, the set of ribs can be considered as one rib with distinctportions, or the set of ribs can be considered as multiple ribs.

As shown schematically in FIGS. 1A-1B, a surgical table 100 includes atable top 120, a table support 122 and a table base 150. The table top120 has an upper surface on which a patient P can be disposed during asurgical procedure, as shown schematically in FIG. 1A. The table top 120is disposed on the support 122, which can be, for example, a pedestal,at a suitable height above the floor. The support 122 (also referred toherein as a pedestal) may provide for movement of the table top 120 in adesired number of degrees of freedom, such as translation in the Z axis(height above the floor), Y axis (along the longitudinal axis of thetable), and/or X axis (along the lateral axis of the table), and/orrotation about the Z, Y, and/or X axis. The table top 120 may alsoinclude multiple sections that are movable relative to each otheralong/about any suitable axes, e.g., separate sections for each of thetorso, one or both legs, and/or one or both arms, and a head supportsection. Movement of the table top 120 and/or its constituent sectionsmay be performed manually, driven by motors, controlled remotely, orthrough any other suitable means. The support 122 for the table top 120may be mounted to the base 150. In some embodiments, the height of thesupport 122 can be adjusted, which together with, for example, themotion (e.g., axial (longitudinal) or lateral motion) of the table top120, can allow for the table top 120 to be positioned at a desiredsurgical site at a certain height above the floor (e.g., to allowsurgeon or other medical professional access) and a certain distancefrom the support 122.

FIGS. 2A-8 illustrate various embodiments describing apparatus andmethods for stabilizing a surgical table on a surface (e.g., a floor ofan operating room). As described above and in accordance with variousembodiments disclosed in more detail below, a surgical table can includea base configured to support other components of the surgical table(e.g., table top, pedestal, robotic arms and associated equipment,and/or the like) and a patient disposed on the surgical table, whilesimultaneously remedying undesirable consequences associated withirregularities in a floor or other surface on which the table isdisposed, and/or other undesirable load imbalances (e.g., due tolocation and/or movement of equipment coupled to the surgical tableand/or movement of a patient lying on the surgical table) during asurgical procedure.

For example, as shown schematically in FIGS. 2A (bottom view) and 2B(side view), a base 250 for a surgical table includes a base body 255and a support assembly 260 coupled to the base body 255. The base 250 isconfigured to support a surgical table load, and to monitor and/oradjust distribution of a total load (the table load together with theweight of the base) to a surface (e.g., a floor within a surgical room).The table load is a collective load including loads from variouscomponents of a surgical table, such as, for example, a table top, apedestal, surgical tools and associated components, robotic arms, andthe like, and a patient. The surgical table can be the same or similarin structure and function to the surgical table 100 described above. Forexample, the surgical table can include a table support and a table tophaving an upper surface on which a patient P can be disposed during asurgical procedure.

As shown in FIG. 2B and described in further detail herein, the supportassembly 260 has a first end coupled to the base body 255, and a secondend (also referred to herein as surface-engaging end) opposite andextending from the first end arranged to transmit the total load fromthe base body 255 to the surface. In some instances, the supportassembly 260 and the base body 255 are monolithically constructed, whilein other instances, the support assembly 260 is formed separately fromand then coupled to the base body 255.

The support assembly 260 includes at least four support members 262.Each support member 262 is configured to transmit a portion of the tableload to the surface. With four support members 262 spaced about the basebody 255, any three support members 262 from the support assembly 260define a plane. Specifically, the surface-engaging ends of any threesupport members 262 from the support assembly 260 define a plane. Thethree support members 262 can thus support the table on a surface,including an uneven surface, without wobbling or excessive vibration.However, it is desirable to support the table on the floor or othersurface at four or more points to provide a more stable support, e.g. tobe more resistant to tipping . . . . As shown in FIG. 2C, a base withthree points of support on the floor or other surface has a triangularregion of stability RS defined by the three points of support. If thecenter of gravity GC of the table (i.e. the total load) is disposedwithin the triangular RS, the table remains upright. However, if the CGis displaced outside of RS, the table can tip. The CG may shift fornumerous reasons, including being on a non-level floor, movement of thetable top sections, attachment of surgical accessories to the table,and/or movement of robotic arms attached to the table. As is apparentfrom FIG. 2C, relatively small movements of the CG can move it outsideof TS. In contrast, as shown in FIG. 2D, a base with four points ofsupport on the floor has a rectangular (or other four sided geometricshape) region of stability RS. The CG must be shifted a larger distancebefore it moves outside of RS. Thus, a base with four points of contactwith the floor or other supporting surface is more stable, i.e. betterable to accommodate movement of the CG without tipping

A problem with having four support members, however, is that it canintroduce another source of instability, e.g., wobbling or excessivevibration, or insufficient resistance to propagation of vibration. Forexample, if the floor surface is not flat and/or if any of the supportmembers are uneven in length (e.g., due to manufacturing tolerances,defects, and/or wear and tear), one of the four support members may beout of contact with the floor, or may carry an insufficient portion ofthe total load to be in sufficiently firm contact with the floor. Thisproblem is more pronounced for a more stiff structure in the base,because the base is less able to flex to accommodate variations in thefloor, i.e. is less compliant.

To limit, reduce, or otherwise prevent such instability, at least one ofthe support members 262 is adjustable relative to the remaining supportmembers 262 and/or the base body 255. For ease of explanation, in thisembodiment, the adjustable support member is identified as 262′.Specifically, the adjustable support member 262′ is adjustable to moveits surface-engaging end relative to a plane defined by thesurface-engaging ends of the three other support members 262. In thismanner, in use, adjusting the adjustable support member 262′ changes theportion of the total load carried by one or more of the support members262 and/or the adjustable support member 262′ itself.

As also shown in FIG. 5 , the adjustable support member 262′ includes afixed section 264 and a movable section 266 configured to move relativeto the fixed section 264 and/or relative to the base body 255. Themovable section 266 can be coupled to the fixed section 264 in anysuitable manner. In some embodiments, for example, the movable section266 and the fixed section 264 can be monolithically constructed, whilein other embodiments the movable section 266 and the fixed section 264can be formed separately and then joined together. Further, the movablesection 266 can be movable relative to the fixed section 264 in anysuitable manner. For example, in some embodiments, the movable section266 can be at least partially slidably disposed within or with respectto the fixed portion 264. In this manner, for example, to shorten theheight of the adjustable support member 262′, the movable section 266can be slid into or along a portion of the fixed portion 264. In otherembodiments, the movable section 266 can be at least partially disposedabout the fixed portion 264 such that the height of the adjustablesupport member 262′ can be adjusted by sliding at least a portion of thefixed portion 264 into the movable portion 266. The relative movement ofthe movable section 266 and the fixed portion 264 can be produced by anysuitable actuator 268. For example, the actuator 268 can include a motorand any suitable mechanism (e.g. rack and pinion, nut and leadscrew,hydraulic or pneumatic pump) to enable the motor to generate the desiredmotion. The motor may be electric, coupled to a suitable power source,and its activation and deactivation may be initiated by a controlsignal, manual user input (such as by a switch), or other suitablemeans. The actuator may be a hydraulic or pneumatic system, with thepressure and flow rate of the liquid or gas driven by any suitablemechanism such as a pump (driven by an electric motor, manually, etc.)and converted to linear motion via piston and cylinder.

To illustrate the adjustability of the adjustable support member 262′,FIG. 3A illustrates schematically in side view the base of FIGS. 2A and2B, showing the surface-engaging ends of three of the support members262 defining a plane PL and the surface-engaging end of the adjustablesupport member 262′ movable relative to the plane PL. The range ofmotion along the Z axis of the surface-engaging end of the adjustablesupport member 262′ is shown in dotted line format. As illustrated inFIG. 3A, for example, the range of motion of the surface-engaging end ofadjustable support member 262′ is shown such that the surface-engagingend can extend above and below the plane PL defined by the remainingsupport members 262.

To illustrate the adjustability of the support member 262′ toaccommodate a non-flat surface while optimizing base 250 stability, FIG.3B illustrates schematically in side view the base body 255 and supportassembly 260 of FIG. 3 , showing the surface-engaging ends of three ofthe support members 262 contacting a flat portion of a support surface Sthat has an irregularity, and the surface-engaging end of the adjustablesupport member 262′ is arranged such that it is in contact with theirregularity of the otherwise flat support surface S. In this manner,the adjustable support member 262′ can be selectively placed in contactwith the surface S such that the adjustable support member 262′ and theremaining support members 262 transmit a desirable portion of the tableload to the surface S, thereby optimizing load balancing and stabilityof the base 250.

FIGS. 4A and 4B show the base 250. The forces imposed on it by the tableload, and the resultant total load (the table load together with theweight of the base 250) acting through the center of gravity CU of theentire table (including the base), and the reactive force that iscarried by each of the four support members 262, i.e. forces F1, F2, F3,and F4. As shown in the bottom view of the base in FIG. 4B, the forcesF1-F4 are directed toward the base, in the +Z direction, indicated by anX. The total load acts in the −Z direction, indicated by a dot. Althoughthe CU of the table is shown approximately centered between the foursupport members 262, the CG may be anywhere within the rectangle boundedby the support members 262. In addition, during a surgical procedure,the table load is dynamic. For example, various movements of components(e.g., movement of the table top or equipment such as robotic arms orsurgical tools), movement of a surgeon or other medical professionals,and movement of the patient. This can result in changes to the magnitudeof the table load and to the location of the center of gravity. Thus,the portion of the total load carried by each of the support membersneed not be equal, and can vary during a procedure. As noted above,irregularities in the floor or other support surface can affect thedistribution of the total load across the four support members, and thatdistribution can be changed by movement of an adjustable support member.

To enable the detection and/or determination of the amount of forcecarried by one or more of the support members, and thus to enable anevaluation of whether the force for one or more of the support membersshould be changed by adjustment of one or more of the support members,the base 250 may include one or more load sensors 270 disposed andconfigured to detect a portion of the total table load carried by one ofthe support members 262. In this embodiment, a load sensor 270 is shownin FIG. 5 as being coupled to the adjustable support member 262′,however, in other embodiments, the load sensor 270 can be coupled to anysuitable portion of the base 250 such that the load sensor 270 cansensor the portion of the total load carried by at least one of thesupport members 262.

The load sensor 270 can be any suitable device configured to sense aload, such as a pressure sensor (to sense hydraulic and/or pneumaticpressure in embodiments in which the some or all of the total load iscarried on a hydraulic and/or pneumatic element), a strain gauge sensor,a vibrating wire sensor, a capacitive sensor, and the like. For example,in some embodiments, the load sensor 270 can include a piezoelectrictransducer, and the transducer can be coupled to a support member 262(e.g., surface-engaging end of the support member 262 and/or theactuator 268) such that the transducer is strained by load carried bythe support member. In some embodiments in which the adjustable supportmember 262 is hydraulically actuated, for example, the load sensor 270can be disposed to detect a pressure of the hydraulic fluid.

The load sensor 270 may be operably coupled to a controller 202 thatcan, for example, control adjustment of the adjustable support member262′ via the actuator 268 based on measurements acquired by the loadsensor 270. As shown schematically in FIG. 6 , the controller 202 caninclude a memory 206, a processor 204, and various components or modulesthat are part of, or separate from, the processor 204 for interactingwith other devices. For example in the illustrated embodiment, theprocessor 204 includes an input/output module 210 (or interface) thatreceives data signals from the load sensor 270 and may convey them to aload feedback module 212. Optionally (as indicated by dashed lines), theinput/output module 210 may send output signals to a user display toprovide a visual indication of information about the load carried by thesupport members, the location of the CG, and/or other information. Theload feedback module 212 may receive the load signal from the loadsensor 270, via the input/output module 210. The load feedback module212 includes circuitry, components, and/or code to produce a controlsignal to send to the actuator 268 to control movement of the movableportion 266 of the adjustable support member 262′. In some embodiments,the controller 202 includes a position feedback module 214 that receivesa position, velocity, and/or acceleration information associated withmovement of the movable portion 266 of the adjustable support member262′. The controller 202 can be coupled to a computer (not shown) orother input/output device via the input/output module 210.

The processor 204 can be any processor configured to, for example, writedata into and read data from the memory 206 of the controller 202, andexecute the instructions and/or methods stored within the memory 206.Furthermore, the processor can be configured to control operation of themodules within the controller (e.g., the load feedback module 212 andthe position feedback module 214). Specifically, the processor canreceive a signal including user input, load data, pressure data,distance measurements or the like and determine an amount of movementfor the adjustable support member 262′, and/or an amount of force to beapplied by the actuator 268. In other embodiments, the processor 204 canbe, for example, an application-specific integrated circuit (ASIC) or acombination of ASICs, which are designed to perform one or more specificfunctions. In yet other embodiments, the processor can be an analog ordigital circuit, or a combination of multiple circuits.

The memory 206 can be any suitable device such as, for example, a readonly memory (ROM) component, a random access memory (RAM) component,electronically programmable read only memory (EPROM), erasableelectronically programmable read only memory (EEPROM), registers, cachememory, and/or flash memory. Any of the modules can be implemented bythe processor 204 and/or stored within the memory 206.

In some embodiments, in use, if a portion of the total load supported bya particular support member 262 as measured by the load sensor 270 fallsbelow a predetermined threshold, the controller 270 can adjust theadjustable support member 262′ such that the portion of the table loadsupported by that particular support member 262 returns to an acceptablelevel (e.g., a minimum threshold load or proportion of the load).Further, in some embodiments, the adjustable support member 262′ can beoperably coupled to a position sensor (not shown) that can sense aposition of the adjustable support member 262′, e.g., to determine therange of motion available to the adjustable support member. For example,the position sensor can detect a distance that the movable portion 266of the adjustable support member 262′ is extended from the fixed portion264 to determine if and by how much the adjustable support member can beadjusted in either direction, e.g., raised or lowered relative to thefloor surface. In other embodiments, any suitable position indication ormeasurement can be used (e.g., a percentage of the maximum extensionheight).

In some embodiments, the base 250 can include any suitable number ofload sensors 270. For example, in some embodiments, each support member260 can be operably coupled to a load sensor 270 such that a portion ofthe total load supported by each support member 270 can be determined.In this manner, in use, in response to detecting that a portion of thetable load carried by any one or more of the support members 260 is notwithin an acceptable range, the adjustable support member 270 can beadjusted to change the portion of the table load carried by one or moreof the support members 260. Maintaining suitable distribution of thetable load in this way can encourage stability and limit, reduce orprevent wobbling or vibration of the surgical table 200.

In some embodiments, the support assembly 260 can include multipleadjustable support members 262′ (e.g., two, three, four, five or more).In such embodiments, each adjustable support member 262′ may be operablycoupled to a load sensor 270, and each load sensor 70 can detect aportion of the total load carried by the adjustable support member 262′to which it is coupled. In such embodiments, each adjustable supportmember 262′ can be independently controlled and adjusted (e.g., raisedand/or lowered) to achieve a desired amount of total load distributionacross the adjustable support members 262′.

Determining when to adjust an adjustable support member 260 can be basedon any suitable table load balancing plan. For example, in someembodiments, a total load balancing plan can include defining anacceptable range of load to be carried by one or more of the supportmembers 260 or adjustable support members 262′. This acceptable range,in some instances, can be based on the total load. In some instances, anacceptable range can be a percentage of the total load. For example, atotal load balancing plan can include an acceptable range of about 1percent to about 40 percent of the total load. In such cases, if theportion of the total load supported by any of the support members 262falls outside of the acceptable range, one or more of the adjustablesupport members 262′ will be adjusted to redistribute the total loaduntil one or more, or all, of the support members 262 are supported aportion of the total load within the acceptable range.

In some embodiments, the total load balancing plan can includedetermining and/or tracking the location of the center of gravity CG ofthe surgical table 200. The center of gravity CG can be determinedand/or calculated based on load information sensed by the load sensors270. For example, as described in connection with FIG. 2D, the center ofgravity CG may be centered within a region of stability RS bounded bythe support members 262. In practice, however, as described above, dueto irregularities in the support surface, dynamic forces results fromsurgical procedures, and/or movement of components of the table loadduring a surgical procedure, the location of the CG may shift to alocation unacceptable close to the boundary of the RS. To detect suchinstances, in some embodiments, the location of the center of gravity CGcan be determined and tracked in real-time (e.g., during a surgicalprocedure). If, for example, the center of gravity CG reaches athreshold distance from the boundary, the controller 202 can detect suchan event and respond in any suitable manner, such as, for example,sending a signal to alert the surgeon or other medical staff, and/or asignal to adjust one or more of the adjustable support members 262′and/or additional stabilizing support members to provide desired stablesupport.

In some embodiments, adjustment of an adjustable support member may beinitiated automatically in response to a determination that the totalload needs to be redistributed. In another embodiment, adjustment of anadjustable support member may occur only when the base is beingconfigured to a fixed arrangement with the floor. In other embodiments,the adjustable support member can be actuated manually by a user. Insuch embodiments, the base can be operably coupled to and/or can includea user display, such as user display 290 illustrated schematically inFIG. 6 , and when the controller, for example, determines that theportion of the table load is not within an acceptable range, thecontroller can send a signal to the user display to generate on the userdisplay an instruction to a user to actuate the actuator to move thesurface-engaging end of the adjustable support member to change theportion of the table load carried by at least one of the supportmembers. Further, in some instances, for example, when the controllerdetermines that the portion of the table load is not outside of theacceptable range, the controller can send a signal to the user displayto generate on the user display an indication that the user can ceaseactivation of the actuator. In some embodiments, any type of visual,audio, and/or tactile feedback or alert can be generated to alert a userof a condition, such as an unacceptable load distribution.

Surgical tables, in addition to be structurally rigid and adjustable toaccommodate for irregularities, can be mobile to allow for wheeledtransport around the hospital. For example, as shown schematically inFIGS. 7A (bottom view) and 7B (side view), a base 350 for a surgicaltable includes a base body 355 and a support assembly 360 coupled to thebase body 355. The base 350 can be the same or similar in structure andfunction to the base 350 described above, except the base 350 includes awheel 380 to support the base 350 for movement on the surface (e.g.,such that the surgical table can be wheeled around the operating roomand/or around other areas of a hospital).

The base 350 can include any suitable number of wheels 380 to supportthe base 350 for movement on the surface, and can be coupled to the base350 in any suitable location and any suitable manner. For example, insome embodiments, the base 350 can include two, three, four, or morewheels or casters to support the base 350 for movement on the surface.Further, in some embodiments, the wheel 380 is physically separate fromthe support members 360 (including the adjustable support member 362′),while in other embodiments, the wheel is included, coupled to, and/orintegrated with a support member 360 (optionally including theadjustable support member 362′). For example, in some embodiments, oneor more wheels 380 can be coupled to one or more of the support members362 and can define at least in part the surface-engaging end of supportmember 362 to which it is coupled.

In some embodiments, one or more wheels 380 of the base 350 is movableupwardly (e.g., along the Z axis) relative to the surface-engaging endsof the support members to change the base 350 from a movablearrangement, in which the base 350 is supported only one the wheels 380and movable relative to the surface on the wheels 380, to a fixedarrangement in which the base 350 is supported at least in part by atleast two of the support members 362 and fixed relative to the surface.In this manner, the base 350 can be transitioned from a movablearrangement to a fixed arrangement, and vice versa, such that thesurgical table can be moved around the hospital to a desired location,and then fixed to the surface in preparation for the surgical procedure.In some embodiments, in the fixed arrangement, the base 350 is supportedonly by the support members 362 (e.g., and not a wheel 380).

In some embodiments, the surface-engaging ends of at least two supportmembers 362 are movably downwardly relative to the wheels 380. In thismanner, the base 350 can be changed from a movable arrangement in whichthe base 350 is supported only on the wheels 380 and movable relative tothe surface on the wheels 380, to a fixed configuration in which thebase 350 is supported at least in party by the at least two supportmembers 362 and fixed relative to the surface. In some embodiments, thesurface engaging ends of at least four of the support members 362 aremovable downwardly relative to the wheels 380, and in the fixedarrangement, the base 350 is supported only by the support members 362.Each of the support members 326 may be an adjustable support member, anddownward movement of the surface engaging portion of each of the supportmembers 362 may therefore include movement of an adjustable portion ofthe support member by an actuator in the same manner as the adjustablesupport member 262′ described above.

FIG. 8 is a flow chart that illustrates a method 400 of stabilizing asurgical table on a surface with a base such as the base 250 or 350described above. In some embodiments, the method includes receiving at402 a signal from the load sensor indicative of the portion of the totalload carried by the one of the support members. The method optionallyfurther includes receiving at 404 a signal from an adjustable supportmember indicative of an adjustment position (e.g., a position of themovable portion of the adjustable support member relative to the basebody and/or fixed portion). The method further includes comparing at 406the portion of the total load to an acceptable range. If, at 408, theportion of the total load is determined not to be within the acceptablerange, then the method optionally further includes, at 410, determiningthe adjustability of the adjustment member based at least in part on theadjustment position and determining if the adjustability is sufficientto achieve optimal stability. If the adjustability is sufficient toachieve optimal stability, then the method further includes, at 412,causing the surface-engaging end of the adjustable support member tomove relative to a plane defined by the surface-engaging ends of threeof the other support members and thereby to change the portion of thetotal load carried by one of the support members. If the adjustabilityis determined to be insufficient to achieve optimal stability, then themethod optionally further includes, at 414, sending a signal indicativeof an alert that the surgical table may not be optimally stable. If, at406, the portion of the total load is determined to be within theacceptable range, then the method may return to receiving at a latertime another signal from the load sensor, and repeating the method from402. The method may further include after causing the movement of thesurface-engaging end of the support member to move and/or after sendingthe signal indicative of the alert, returning to 402 to receive anupdated signal from the load sensor and repeating the method until theportion of the total load is within the acceptable range.

Although in various embodiments described herein, the support assemblyas illustrated and explained included a particular number of supportmembers, and particular number of which are adjustable, in otherembodiments, a support assembly can include any suitable number ofsupport members and any suitable number of adjustable support members.For example, in some embodiments, a support assembly can include foursupport members, and all four support members can be adjustable. In yetother embodiments, a support assembly can include more than four supportmembers, such as, for example, five or more support members. Forexample, in some embodiments, a support assembly can include fivesupport members, and four of the five support members can benon-adjustable relative to the base body and/or the other support member(e.g., the adjustable support member. Similarly, a base can include anysuitable number of wheels and any suitable number of load sensors, andthose wheels and load sensor can be coupled to any suitable portions ofthe base.

As described above, it is desirable to reduce unwanted vibration at theworking ends of the robotic arms of a robotic surgical system. Roboticsurgical systems can include robotic surgical arms that are coupled,directly or indirectly, to a surgical table on which a patient can besupported during a surgical procedure. The robotic surgical arms maysupport at their distal, working ends various devices, includingsurgical instruments, cannulae for providing access to the patient'sbody cavity(ies) and organ(s) for application of surgical instruments,imaging devices, lights, etc. In such systems, it is desirable toestablish and maintain high positional accuracy for the devices mountedon the distal ends of the robotic arms.

Positional accuracy can be reduced or degraded by vibration of thedistal ends of the robotic arms. Such vibration may be in the form ofvibrational cross-talk, which is unwanted vibration occurring in onepart of the system that originates in another part of the system. Forexample, vibration may be induced within a robotic arm, such as byoperation of a motor driving movement of some portion of the armrelative to another portion of the arm and/or to the surgical table orother supporting structure, and the energy introduced into the arm byoperation of the motor may propagate through the atm to the distal end,inducing vibration in the distal end. This arm may be referred to as the“active” arm. Alternatively, or additionally, energy introduced into theactive arm, such as by operation of a motor within the active arm, maypropagate through the active arm, through the table or other supportingstructure, and through another robotic arm (which may be referred to asthe “passive” arm) to the passive arm's distal end. It is desirable toreduce vibrational cross-talk to enhance positional accuracy of thedistal ends of robotic arms and the devices attached thereto.

To address vibrational cross-talk and positional accuracy of the distalends of robotic arms and the devices attached thereto, apparatus andmethods for providing a robotic surgical system including a surgicaltable having a table top on which a patient can be disposed aredescribed in various embodiments herein with respect to FIGS. 9A-23B. Insome embodiments, an apparatus includes a surgical table and roboticarms coupled, or coupleable to, the surgical table, with each roboticarm supporting a medical instrument, such as a surgical tool, tooldriver, cannula, light, and/or imaging device. The surgical tableincludes a base, a pedestal or column, and a table top coupled to thecolumn. Each of the robotic arms may be coupled to at least one of thetable top, the column or the base. Each robotic arm provides two or morelinks between the proximal end of the arm (at which the arm is coupledto the table) and the distal end of the arm (at which the arm is coupledto the medical instrument). The links are coupled to each other, and maybe coupled to the table and to the medical instrument, by a joint thatprovides one or more degrees of freedom of relative movement between thelinks coupled by the joint, and correspondingly one or more degrees offreedom of relative movement between the distal end of the robotic armand the surgical table. The links and corresponding degrees of freedomallow for movement of the distal end of the robotic arm about and/oralong the X, Y, and/or Z axes, to a desired location relative to thetable top and/or a patient disposed thereon and/or a desired targetportion of the anatomy of a patient disposed thereon. Relative movementof the links about the joints can be initiated and continued byoperation of devices such as motors, and/or resisted or stopped byactive devices such as motors and/or passive devices such as brakes. Asnoted above, such devices can introduce energy into the robotic surgicalsystem, which can produce unwanted vibrations at the distal ends of therobotic arms.

In some embodiments, an apparatus includes a surgical table having apatient table top, an adapter coupled to the surgical table, and one ormore robotic arms coupled to the adapter. In some embodiments, anapparatus can include a surgical table having a patient table top and anadapter/robotic arm assembly coupled to the surgical table. For example,the adapter and robotic arm can be an integral mechanism or component.Each of the adapter and the robotic arms, or an adapter/robotic armassembly, can include one or more links to allow for movement of theadapter and/or arms about and/or along the X, Y, and/or Z axes, to adesired location relative to the table top and/or a patient disposedthereon and/or a desired target portion of the anatomy of a patientdisposed thereon.

In some embodiments, the robotic arm can be releasably coupled to thesurgical table. In some embodiments, the robotic arm can include areleasable coupling between its proximal end and its distal end, suchthat the proximal portion of the robotic arm can be coupled to thesurgical table and the distal portion of the robotic arm can be removedfrom the proximal portion. In some embodiments, the proximal portion ofthe robotic arm can be implemented as an adapter, which may be fixedlycoupled to the surgical table. The adapter can include a table interfacestructure or mechanism, a first link member pivotally coupled to theinterface structure at a first joint, and a second link member coupledto the first link member at a second joint. In some embodiments, thesecond link member can be pivotally coupled to the first link member atthe second joint. The second link member is also configured to becoupled to a robotic arm at a coupling that includes a coupling portionof the second link member and a coupling portion at a proximal ormounting end portion of the robotic arm. The robotic arm also includes atarget joint at the mounting end portion of the robotic arm. In someembodiments, the target joint is included with the coupling portion atthe mounting end portion of the robotic arm.

The robotic arm can be used to perform a surgical procedure on a patientdisposed on the surgical table. The first joint can provide forrotational motion of the first link member about a vertical Z-axisrelative to a table top of the surgical table and movement of the firstlink member and the second link member in lateral and longitudinaldirections (also referred to herein as X-direction and Y-direction)relative to the table top of the surgical table. The second joint canprovide a lift mechanism to allow for vertical movement (e.g. movementcloser to, above, and/or further above, the table top of the surgicaltable) of the second link member and the mounting end portion of arobotic arm coupled thereto. The collective movement of the first linkmember and the second link member allows for the adapter and a roboticarm when coupled thereto to move between a variety of differentpositions relative to the surgical table. For example, the adapter androbotic arm can be moved to a stowed position, and various operatingpositions where the target joint of the robotic arm can be placed at atarget location to perform a particular surgical procedure on a patientdisposed on the table top of the surgical table. The motion of the firstlink member and the second link member also provides for movement of theadapter and robotic arm to various parked or clearance positions inwhich the adapter and robotic arm are disposed such that access to thepatient is not obstructed. For example, it may be desirable to move theadapter and robotic arm during a surgical procedure to provide clearancefor equipment such as an imaging device and/or to provide clearance foradditional medical personnel in, for example, an emergency during theprocedure. In some cases, an operating position can also be a parkedposition.

As shown schematically in FIGS. 9A-9B, a surgical table 500 includes atable top 520, a table support or column 522 and a table base 524. Thetable top 520 has an upper surface on which a patient can be disposedduring a surgical procedure, as shown schematically in FIG. 9A. Thetable top 520 is disposed on the column 522, which can be, for example,a pedestal, at a suitable height above the floor. The column 522 mayprovide for movement of the table top 520 in a desired number of degreesof freedom. For example, as illustrated schematically in FIG. 9A, thecolumn 522 may have two sections that telescope relative to each otherto provide translation in the Z axis (height above the floor).Additionally, or alternatively, the table top 520 may be movablerelative to the base 550 along the Y axis (along the longitudinal axisof the table), and/or the X axis (along the lateral axis of the table),and/or about the Z, Y, and/or X axis. The table top 520 may also includemultiple sections that are movable relative to each other along/aboutany suitable axes, e.g., separate sections for each of the torso, one orboth legs, and/or one or both arms, and a head support section. Movementof the table top 520 and/or its constituent sections may be performedmanually, driven by motors, controlled remotely, etc. The column 522 forthe table top may be mounted to the base 524, which can be fixed to thefloor of the operating room, or can be movable relative to the floor,e.g., by use of wheels on the base. As shown schematically in FIG. 9A,in some embodiments, the height of the column 522 can be adjusted, whichtogether with, for example, the motion (e.g., axial (longitudinal) orlateral motion) of the table top 520, can allow for the table top 520 tobe positioned at a desired surgical site at a certain height above thefloor (e.g., to allow surgeon access) and a certain distance from thecolumn 520. This also can allow robotic arms 530 coupled to the table500 to reach a desired treatment target on a patient disposed on thetable top 520.

In a robotically assisted surgical procedure, one or more robotic arms530 can be disposed in a desired operative position relative to apatient disposed on the table top 520 of the surgical table 500 (alsoreferred to herein as “table”), as shown schematically in FIGS. 9C and9D. The robotic arm(s) can be used to perform a surgical procedure on apatient disposed on the surgical table 500. In particular, the distalend of each robotic arm can be disposed in a desired operative positionso that a medical instrument coupled to the distal end of the roboticarm can perform a desired function.

In accordance with various embodiments, each robotic arm 530 may bepermanently, semi-permanently, or releasably coupled to the table top520 via a coupling 518, as shown in FIGS. 9C and 9D. The coupling 518can include a variety of different coupling mechanisms, including acoupling portion (not shown) on the table top 520 that can be matinglycoupled to a coupling portion (not shown) on the robotic arm. Eachrobotic arm 530 can be coupled at a fixed location on the table 500 orcan be coupled such that the robotic arm 530 can be movable to multiplelocations relative to the table top 520 and/or a patient disposed on thetable top 520 as described in more detail herein. For example, therobotic arm 530 can be moved relative to the table top 520 and/or aspecific target treatment location on the patient. In some embodiments,the axial motion (e.g., in the Y-axis direction) of the table top 520can assist in allowing the arms 530 (and therefore, the medicalinstrument or tool coupled to the distal end of the arm) to reach thedesired anatomy on the patient or provide clearance for access to thepatient as needed. In some embodiments, the combination of verticalmovement of the column 522, axial movement of the table top 520 andmovement of, for example, links in the robotic arm 530 allow the roboticarm to be placed in a position where it can reach the anatomy of thepatient at the required height over the floor.

As shown schematically in FIGS. 10A and 10B, each robotic arm 530 caninclude a distal end portion 537 and a proximal end portion 536. Thedistal end portion 537 (also referred to herein as “operating end”) caninclude or have coupled thereto a medical instrument or tool 515. Theproximal end portion 536 (also referred to herein as the “mounting endportion” or “mounting end”) can include the coupling portion to allowthe robotic arm 530 to be coupled to the table top 520 of the table 500.The robotic arm 530 can include two or more link members or segments 510coupled together at joints that can provide for translation along and/orrotation about one or more of the X, Y and/or Z axes. The couplingportion of the robotic arm 530 to couple the robotic arm 530 to thetable top 522 at the coupling 518 can be disposed at the distal ormounting end 536 of the arm 530 and may be coupled to a segment 510 orincorporated within a segment 510. The robotic arm 530 also includes atarget joint J1 disposed at or near the mounting end 536 of the roboticarm 530 that can be included within the coupling portion of the coupling518 or disposed on a link or segment 510 of the robotic arm 530 coupledto the coupling portion. The target joint J1 can provide a pivot jointto allow a distal segment of the robotic arm 530 to pivot relative tothe table top 520. The robotic arm 530 can be moved between variousextended configurations for use during a surgical procedure, as shown inFIG. 10A, and various folded or collapsed configurations for storagewhen not in use, as shown in FIG. 10B.

In some embodiments the connection between the surgical table and thedistal end of the robotic arm (and thus the position and orientation ofthe medical instrument at the distal end of the robotic arm relative tothe patient), is implemented with an adapter 528 and robotic arm(s) 530coupled to the adapter 528, as shown in FIGS. 11A and 11B. The adapter528 can be separate from, but engageable with, or coupleable to, thesurgical table 500, or can be fixedly attached to the surgical table500. The adapter 528 can be coupled to, for example, the column 522, thetable base 524 and/or the table top 520 of the table 500. However, thedistinction between an adapter and robotic arm can be disregarded, andthe connection between the surgical table and the distal end of therobotic arm can be conceptualized and implemented as a series of linksand joints that provide the desired degrees of freedom for movement ofthe medical instrument, i.e. at the distal end of the connection. Theconnection may include a releasable coupling at any one or more link(s)or joint(s) or any location along the series of links and joints.

As described herein, in some embodiments, the various sections of thetable top 520 can move relative to each other (e.g., can be tilted orangled relative to each other) and/or the table top 520 can be moved(e.g., tilted, angled) relative to the column 522 and/or the base 524 ofthe surgical table 500. In some embodiments, it is contemplated that theadapter 528 and robotic arms 530 coupled thereto can move with the torsosection of the table top 520 such that the frame of reference to the X,Y and Z axes for various embodiments remains relative to the top surfaceof the table top 520. In some embodiments, the adapter 528 and roboticarms 530 can be coupled to the support pedestal 522 of the table 500 andwhen the table top 520 is moved relative to the support 522, thepositioning of the adapter 528 and arms 530 can be coordinated with themovement of the table top 520.

As shown schematically in FIGS. 12A and 12B, the adapter 528 can includea table interface structure or mechanism 540, and one or more linkmembers. In this example embodiment, the adapter 528 includes a firstlink member 532 coupled to the interface structure 540 at a first joint533, and a second link member 534 coupled to the first link member 532at a second joint 535. In some embodiments, the first link member 532can be pivotally coupled to the table interface structure 540 at thefirst joint 533. In some embodiments, the first link member 532 can becoupled to the table interface structure 540 with a joint that providesfor linear motion. In some embodiments, the second link member 534 canbe pivotally coupled to the first link member at the second joint. Othertypes of coupling joints for the first joint 533 and the second joint535 can alternatively be used. Thus, various different types of couplingjoints (e.g., linear, rotational) can be used between the link membersof the adapter to achieve a desired movement and reach of the adapter.The second link member 534 is also coupleable to a robotic arm 530 at acoupling 518 (also referred to herein as “coupling joint”). The adapter528 can be moved between various extended configurations for use duringa surgical procedure as shown in FIG. 12A, and various folded orcollapsed configurations for storage when not in use, as shown in FIG.12B.

In some embodiments, the adapter 528 can include more than two linkmembers. For example, an adapter can include a third link member (notshown) coupled to the second link member 534 between the second linkmember 534 and the coupling 518 to the robotic arm 530. In otherembodiments, more than three link members can be included. The numberand size of link members can vary such that the adapter 528 can providea longer or shorter reach to extend the robotic arm 530 (e.g., thetarget joint J1 discussed below), for example, further above thepatient, for larger patients. It can also be used to extend the positionof the robotic arm 530 further under the table top 520 when the arm 530is moved to a position on an opposite side of the table 500 as describedin more detail below (e.g., the arm is moved to the opposite side tohave three arms on one side of the table). The first joint 533 and thesecond joint 535 of the adapter 528 can provide for movement of therobotic arm 530 along and/or about the X, Y, and/or Z axes.

In accordance with various embodiments, each robotic arm 530 may bepermanently, semi-permanently, or releasably coupled to the adapter 528via the coupling 518. The coupling 518 can include a variety ofdifferent coupling mechanisms, including a coupling portion (not shown)on the adapter 528 that can be matingly coupled to a coupling portion(not shown) on the robotic arm. Each robotic arm 530 can be coupled at afixed location on the table 500 or can be coupled such that the roboticarm 530 can be movable to multiple locations relative to the table top520 and/or a patient disposed on the table top 520 as described in moredetail herein. For example, the robotic arm 530 can be moved relative tothe table top 520 and/or a specific target treatment location on thepatient. In some embodiments, the axial motion (e.g., in the Y-axisdirection) of the table top 520 can assist in allowing the arms 530 (andtherefore, the medical instrument or tool coupled to the distal end ofthe arm) to reach the desired anatomy on the patient or provideclearance for access to the patient as needed. In some embodiments, thecombination of vertical movement of the support pedestal 522, axialmovement of the table top 520 and movement of, for example, the firstlink member 532 and the second link member 534, allows for placement ofthe robotic arms 530 in a position where it can reach the anatomy of thepatient at the required height over the floor.

Some structural requirements for the adapter 528 can include providing arigid support of the robotic arm 530 while maintaining adjustability forpre-operative and intra-operative position changes of the robotic arm530. In some embodiments, the table adapter 528 can include a means ofholding or locking the adapter 528 at a fixed position to withstand, forexample, the effects of gravity, inertial effects due to robotic armmotion, and/or to withstand accidental bumps from a user or another partof the robotic system (including other robotic arms or table motion).The table adapter 528 can also include one or more sensors for measuringthe spatial position of the adapter 528 and/or angles and displacementsof various joints and coupling points of the adapter 528.

The collective motion of the first link member 532 and the second linkmember 534 of the adapter 528 can provide for movement of the coupling518, and therefore, movement of a robotic arm 530 coupled thereto alongand/or about the X, Y, and/or Z axes. For example, the target joint J1of the robotic arm 530 can be moved to various target treatmentlocations relative to the table 500 to perform a variety of differentsurgical procedures on a patient disposed thereon. The collective motionof the first link member 532 and the second link member 534 also allowsthe adapter 528 and robotic arm 530 to move between a variety ofdifferent positions relative to the surgical table 500 including stowedpositions, operating positions and parked or clearance positions.

FIG. 13 is a top view of a portion of support 522, adapter 528 and arobotic arm 530 illustrating example degrees of freedom associated withthe joints of the adapter 528 and/or robotic arm 530. As shown in FIG.13 , and as described above, the first link member 532 can be coupled tothe interface mechanism 540 at a joint 533 and the second link member534 can be coupled to the first link member 532 at a joint 535. Therobotic arm 530 can be coupled to the second link member 534 at acoupling joint 518 and each of the links 510 of the robotic arm 530 canbe coupled to each other at a joint. As shown in this example, the J1joint of the robotic arm 530 coincides with the coupling joint 518. Insome embodiments, the adapter 528, and more particularly, the interfacemechanism 540 can be movably coupled to the surgical table (e.g., to thesupport 522) at a coupling joint 513 such that a first degree of freedomDOF 1 is provided at the coupling joint 513. In the example of FIG. 13 ,the coupling joint 513 provides for linear movement between theinterface mechanism 540 and the surgical table, i.e. translationparallel to the X axis. In other embodiments, the coupling joint canprovide pivotal or rotational movement of the interface mechanism 540relative to the surgical table. In other embodiments, the interfacemechanism 540 is fixedly coupled to the surgical table, and thus, doesnot move relative to the surgical table.

As also shown in FIG. 13 , a second degree of freedom DOF 2 is providedat the joint 533 between the first link member 532 and the interfacemechanism, and a third degree of freedom DOF 3 is provided at the joint535 between the first link member 532 and the second link member 534. Afourth degree of freedom DOF 4 is provided at the joint 518, J1 betweenthe second link member 534 and a link 510 of the robotic arm 530. Inthis example, each of DOF 2, DOF 3, and DOF 4 are shown as rotationabout the Z axis.

The robotic arm 530 or a portion thereof can be releasably coupled tothe adapter 528 and/or portions (e.g., links) of the robotic arm 530 canbe incorporated into the adapter 528. Thus, the connection between thesurgical table and the distal end of the robotic arm 530 can beconceptualized and implemented as a series of links and joints thatprovide the desired degrees of freedom for movement of the medicalinstrument 515 at the distal end of the connection. The connection mayinclude a releasable coupling at any one or more link(s) or joint(s) orany location along the series of links and joints.

The various degrees of freedom of the links of the adapter 528 and/orrobotic arm 530 provide for movement of the robotic arm 530 andtherefore, a medical instrument 515 disposed at a distal end thereof tobe moved to a variety of different positions and orientations relativeto the table top 520 to perform various different procedures on apatient disposed thereon. The adapters 528 described herein can alsoprovide for variations on the number of robotic arms 530 that arecoupled to the table to use for a particular procedure, and to positionrobotic arms 530 on one or both sides of the table top 520. For example,in some procedures, it may be desirable to position two robotic arms 530on one side of the table top 520 and two robotic arms 530 on an oppositeside of the table top 520. In other procedures, it may be desirable toposition three robotic arms 530 on one side of the table top 520 and onerobotic arm 530 on an opposite side of the table top 520. Although manyof the embodiments described herein describe the use of four roboticarms 530, it should be understood that the number of robotic arms 530 tobe used for a particular surgery can vary and more or less than fourrobotic arms 530 can be used. Various specific example embodiments aredescribed herein demonstrating the movement and location of the roboticarms relative to the table top 520 within a treatment area or treatment“cloud” for various different procedures.

To secure the table adapter 528 at various locations used duringpre-operative setup and/or during surgery, the various joints and/orcoupling locations may utilize braking or locking mechanisms. Forexample, braking mechanisms may provide the ability to hold position atany point in the range of motion of the joint. Braking mechanisms mayinclude, for example, disc-caliper-style, drum-roller-style, or otherfriction-based mechanisms. Locking mechanisms may provide the ability tohold position at any number of discrete positions, but may not allow forcontinuous adjustment. Locking mechanisms can include, for example,disengaging-toothed, disengaging-pinned, or ball-detent, or otherdiscrete position style locking mechanisms. In some embodiments, brakingor locking mechanisms can prevent motion in an unpowered state and bebiased towards a stopped or locked position via a spring or othermechanism. In some embodiments, in a powered state, braking or lockingmechanisms may optionally release or engage depending on the desiredstate of the system.

As shown schematically in FIG. 14 , an energy source ES, such as motorat a joint between two links in active arm 530, in use, can induceunwanted vibration V1 in tool 515 of active arm 530, and/or vibration V2in tool 515′ of passive arm 530′ via interface structure(s) 540 andcolumn 522. For example, energy introduced by the energy source ES inthe active arm 530 may propagate through the active arm 530, through theinterface structure(s) 540 and column 522, and through the passive arm530′ to the tool 515′ of the passive arm 530′, inducing vibration V2 intool 515′. It is desirable to reduce such vibrational cross-talk fromenergy source ES of active arm 530 to tool 515 of active arm 530 and totool 515 of passive arm 530′ to enhance positional accuracy of the tool515 of active arm 530 and tool 515′ of passive arm. In some instances,various components along/about each of three axes of the system may besubject to varying vibrations. In such instances, it is desirable toreduce amplitude of at least the most critical components, if not all ofthe components, to enhance positional accuracy of the distal ends of therobotic arms and the devices attached thereto.

FIGS. 15A-23B illustrate various embodiments of apparatus and methodsfor reducing vibrational cross-talk by separating the modal frequenciesof vibration of the robotic arm and the table structure(s) to which thearms are coupled.

Decoupling the modal vibration frequencies of the arms (or theirconstituent components) from the table reduces the efficiency oftransmission of the energy introduced into the active arm by, forexample the motor and/or brake. For example, if an active robotic armhas a mode of 4 Hertz (Hz), energy introduced into the active roboticarm is best transferred to a passive robotic arm when the interveningstructure to which the two arms are mounted has a mode equal to the modeof the active robotic arm; in this case; a mode of 4 Hz. Transmission ofthe energy introduced into the active robotic arm can be lessened and/orinterrupted by arranging the intervening structure to have a modedifferent than the mode of the active robotic arm; in this case, forexample, the intervening structure can be arranged to have a mode ofabout 6 Hz, thereby creating modal separation between the active arm andthe intervening structure, and thus reducing the efficiency of energytransmission to the passive arm. Less energy transmitted between armsresults in less vibration produced, i.e. lower amplitude in/about one ormore axes.

Conventional surgical tables have a lowest modal frequency of about 6-8Hz. Robotic surgical arms may have lowest modal frequencies on the orderof about 4-6 Hz. To produce desired magnitude of decoupling, it isdesirable to separate table frequency from arm frequency by at leastabout 2 Hz. In some instances, it is preferable to have a tablefrequency that is about two times or more than arm frequency. Indisclosed embodiments, it is preferable for table frequency to be 10 Hzor more, or in some instances more preferably 12 Hz or more.

Several approaches to increasing the lowest modal frequency of the tableare disclosed. As described briefly above, the table can include severalcomponents or subassemblies, including a base; adjustable column, andtable top with one or more relatively moveable components. The lowestmodal frequency for the overall system is typically defined by relativemovement between the components or subassemblies of the surgical table,along or about different axes produced by bending, compression, ortorsion of the structural components coupling the subassemblies.

Another source of undesirable lower modal frequencies is backlash, slopor play m the system, between the subassemblies or components, orbetween the system and the environment. For example, as discussed inAppendix A, if the base of the table is relatively stiff, resistant tobending and/or compression, it is less able to accommodateirregularities in the floor or other surface on which the base issupported. This can produce rocking or other movement of the table,which can lower one or more of the modal frequencies of movement of thesystem.

The lowest frequencies for the system may be defined by bending of thesupport column and/or base, and corresponding sway of the table toprelative to the base. This bending and resulting sway may be in the Y-Zplane (i.e. about the X axis), as shown in FIG. 15A. It may result fromthe center of gravity (CG) of the load carried by the column 522 (i.e.the table top, the robotic arms, the patient, and any other equipmentmounted to the table top or support column) being displacedlongitudinally (along the Y axis) from the center line CL of the column,as shown in FIG. 15A. The bending/sway may also be in the X-Z plane(i.e. about the Y axis), as shown in FIG. 15B. This may result from theCG of the load being displaced longitudinally (along the X axis) fromthe center of the column, as shown in FIG. 15B. The CG may be displacedfrom the CL by positioning of the robotic arms and/or the patient forthe surgical procedure.

As discussed above, the table top may also be pivotable relative to thecolumn to position the table top and patient in a desired orientationfor a given surgical procedure. As shown in FIG. 16A, this pivotalmovement may be about the X axis, i.e. about a pivot 521. As shown inFIG. 16B, this pivotal movement may be about the Y axis, i.e. about apivot 523. Either pivotal movement may also produce a displacement ofthe CU relative to the CL of the column. The mechanism that enables andproduces either or both pivotal movements may also be a source ofbacklash, which, as noted above, can lower the modal frequency of one ormore of the degrees of movement of the table. Described below areseveral embodiments of mechanisms that can enable and/or produce pivotalmovement of the table top but have relatively high structural rigidity,minimize tendency to bend the column, otherwise resist sway of the tabletop relative to the base, and/or reduce sources of backlash in thesystem.

To allow the table top to pivot relative to the column (e.g., alongand/or about the Z, Y, and/or Z axis) to position the table top andpatient in a desired orientation (e.g., a Trendelenburg orientation) fora given surgical procedure, a surgical table can include a pivotassembly coupled to its telescopic column and having actuators operablycoupled to various portions of the table top and arranged to move thetable top into the desired orientation. For example, as shownschematically in FIGS. 17A-17C, such a surgical table 600 includes atable top 620, a table support or column 622, a table base 650, and apivot assembly 660. The table top 620 is disposed on the column 622,which can be, for example, a pedestal, at a suitable height above thefloor. The column 622 includes two sections that telescope relative toeach other to provide translation in the Z axis (height above thefloor), as illustrated schematically in FIGS. 17A and 17C. The surgicaltable 600 can be the same as or similar in structure and function to thesurgical table 500 described herein. Thus, some details regarding thesurgical table 600 are not described below. It should be understood thatfor features and functions not specifically discussed, those featuresand functions can be the same as or similar to any of the surgicaltables described herein.

As discussed in further detail herein, in this embodiment, the pivotassembly 660 is coupled to the column 622. In this manner, the column622 and the pivot assembly 660 can translate simultaneously in the Zaxis (height above the floor). The pivot assembly 660 includes a primaryload support 662, a first actuator 663A, a second actuator 66313, athird actuator 663C, and a support flange 661 arranged to support thepivot assembly 660 and to couple the pivot assembly 660 with the column622, as illustrated schematically in FIGS. 17A-17C.

The primary load support 662 includes a pivot 664 operably coupled tothe table top 620. Similarly as described with respect to pivot 121 andpivot 123, the pivot 664 allows for pivotal movement of the table top620 relative to the column 622 about the X axis and about the Y axis toposition the table top 622 and patient (not shown) in a desiredorientation for a given surgical procedure. Pivot 664 may be implementedwith a gimbal joint arrangement to enable the two-axis pivoting motion.

As illustrated in FIGS. 17A-17C, the pivot assembly 660 is coupled tothe column 622 in a cantilevered fashion. In this embodiment, the column622 is located off the origin of the X and Y axis of the base 650, withthe primary load support 662 disposed near the centerline of the tabletop 620. In this arrangement, the cantilevered pivot assembly 660 andthe table load can collectively cause an undesirable bending moment M(see e.g., FIG. 17C) and shear force on the column 622. The bendingmoment M and shear force on the column 622 can cause wear due toundesirable contact or rubbing between the two sections of the column622 (e.g., between telescoping joints) during their relative movement.Over time, the wear can result in lowered structural rigidity, increasedsway of the table top 620, and/or increased backlash in the system.Further, the cantilevered position of the pivot assembly 660 relative tothe column 622 may lead to the center of gravity being displaced beyondan acceptable boundary defined by the base 650 (e.g., beyond anacceptable distance from the center line of the column 622), for exampleif the patient is disposed more to the opposite side of the table top620, and/or robotic arms are extended on the opposite side of the tabletop 620.

To enable and/or produce pivotal movement of a table top but remedy thedeficiencies illustrated and described with respect to the embodimentshown in FIGS. 17A-17C, rather than coupling the pivot assembly with thecolumn in a cantilevered fashion, the pivot assembly can be arrangedabout the column, and the column can be relocated towards the center ofthe base (rather than off-center as shown an described with respect tothe embodiment shown in FIGS. 17A-17C). In this manner, the location ofthe center of gravity is improved by moving it towards the centralvertical axis of the column). FIGS. 18A-18C illustrate a surgical table700 according to such an embodiment. As shown, in this embodiment, thesurgical table 700 includes a table top 720, a table base 750, a tablesupport or column 722 located at or near the center of the table base750, and a pivot assembly 760 distributed about the column 722. Thetable top 720 is disposed on the column 722, which can be, for example,a pedestal, at a suitable height above the floor. The column 722includes two sections that telescope relative to each other to providetranslation in the Z axis (height above the floor), as illustratedschematically in FIGS. 18A and 18C. The surgical table 700 can be thesame as or similar in structure and function to any of the surgicaltables (e.g., surgical table 500, 600, etc.) described herein. Thus,some details regarding the surgical table 700 are not described below.It should be understood that for features and functions not specificallydiscussed, those features and functions can be the same as or similar toany of the surgical tables described herein.

The pivot assembly 760 includes a primary load support 762, a firstactuator 763A, a second actuator 763B, a third actuator 7630, and asupport flange 761 arranged to support the pivot assembly 760 and tocouple the pivot assembly 260 with the column 722, as illustratedschematically in FIGS. 18A-18C. The actuators 763A, 763B, 763C and theprimary load support 762, are spaced about various sides or portions ofthe column 722, as best illustrated schematically in top view in FIG.18B (section A-A of FIG. 18A). More specifically, the primary loadsupport 762 is connected at its lower end to the support flange 761 at afirst portion of the support flange 761 on one side of the column 722.The primary load support 762 includes a pivot 764 (e.g. a gimbal joint)operably coupled to the lower side of the table top 720. In turn, thesecond actuator 763B is connected at its lower end to another portion ofthe support flange, on the side of the column 722 opposite to theportion of the support flange 761 to which the lower end of the primaryload support 762 is connected. Further, the first actuator 763A isconnected at its lower end to the support flange 761 at a third portionof the support flange on the side of the column 722 between the firstand second portions of the support flange 761, i.e. between the primaryload support 762 and the second actuator 763B, and the third actuator763C is connected at its lower end to the support flange 761 at a fourthportion of the support flange on the opposite side of the column 722from the first actuator 763A, and between the first and second portionsof the support flange 761, i.e. between the primary load support 762 andthe second actuator 763B. Each of the actuators 763A, 763B, and 763C iscoupled at its upper end (e.g. with a gimbal joint) to the lower side ofthe table top 320.

Distributing the pivot assembly 760 about the column 722 in this mannerallows the center of gravity (CG) of the load carried by the column 722(i.e. the table top; the robotic arms, the patient, and any otherequipment mounted to the table top or support column) to be placed at ornear the center of the column 722, thereby limiting or reducing unevenloading at the telescoping column 722, improving stiffness and stabilityof the system, and increasing modal frequency of the table top 720 andthe column 722. In this embodiment, the center of gravity, and thecenter of the column 722 is also be placed at or near the origin of thebase's 750 X axis and Y axis.

An alternative configuration of pivot assembly 760 is shown in FIG. 18D.In this configuration, the portions of the support flange 761 to whichthe lower ends of the primary load support 762 and the actuators 763A,763B, and 763C are attached are configured as discrete lateralprojections from the body of the support flange 761. FIG. 18D alsoillustrates a possible arrangement of drive motors 765A, 765B and 765Cfor the respective actuators 763A, 763B and 763C.

In another embodiment, a surgical table can be the same as or similar instructure and function to the surgical table 500, the surgical table600, and/or the surgical table 700 described herein, except the primaryload support can be relocated to the top end of the column, with theactuators distributed about the primary load support. FIGS. 19A-19Dillustrate a surgical table 800 according to such an embodiment. Asshown, in this embodiment, the surgical table 800 includes a table top820, a table base 850, a table support or column 822 located at or nearthe center of the table base 850, and a pivot assembly 860 disposed ontop of the column 822. The table top 820 is disposed on the pivotassembly 860. The column 822 can be, for example, a pedestal. The column822 includes two sections that telescope relative to each other toprovide translation in the Z axis (height above the floor), asillustrated schematically in FIGS. 19A and 19C.

As shown, the pivot assembly 860 is disposed on top of and coupled tothe top of the column 822 and the bottom of the table top 820. In thismanner, the column 822 and the pivot assembly 860 can translatesimultaneously in the Z axis (height above the floor), and the table top820 can be disposed at a suitable height above the floor. The pivotassembly 860 includes a primary load support 862, a first actuator 863A,a second actuator 863B, a third actuator 863C, and a support flange 861arranged to support the pivot assembly 860 and to couple the pivotassembly 860 with the column 822, as illustrated schematically in FIGS.19A-19C.

In this embodiment, the primary load support 862 is disposed on top ofthe column 822. More specifically, the lower end of the primary loadsupport 862 is disposed within the periphery of the support column 822in a plane transverse to the vertical axis (Z axis) of the column 822,i.e. in the X-Y plane. The upper end of primary load support 862includes a pivot 864 (e.g. a gimbal joint) operably coupled to the lowerside of the table top 820. Disposing the primary load support 862 on topof the column 822 in this manner allows the center of gravity (CG) ofthe load carried by the column 322 (i.e. the table top, the roboticarms, the patient, and any other equipment mounted to the table top orsupport column) to be placed at or near the center of the column 822,thereby limiting or reducing uneven loading at the telescoping column822, improving stiffness and stability of the system, and increasingmodal frequency of the table top 820 and the column 822. In thisembodiment, the center of gravity, and the center of the column 822 isalso placed at or near the origin of the base's 850 X axis and Y axis.Further, disposing the primary load support 863 on top of the column 822and distributing the actuators 863A, 863B, 863C about the primary loadsupport 863 reduces and/or eliminates the undesirable bending moment andshear force described above with respect to FIGS. 17A-17C, therebylimiting or reducing uneven loading at the telescoping column 822,improving stiffness and stability of the system, and increasing modalfrequency of the table top 820 and the column 822.

Disposing the entire pivot assembly 860 on top of column 822, i.e. withall components including the actuators 863A, 863B, and 863C above thetop of the column, increases the height of the table top 820, which canaggravate the bending forces on the column 822 and lower modalfrequency(ies) associated with the column bending. An alternativearrangement is shown in FIG. 19D. In this arrangement support flange 861includes an upper portion 861A coupled to the top of support column 822,a lower peripheral portion 861B, and a side portion 861C connecting thelower peripheral portion 861B to the upper portion 861A. The lower endof primary load support 862 is coupled to the upper portion 861A ofsupport flange 861, and the lower ends of the actuators 863A, 863B, and863C are coupled to the lower peripheral portion 861B.

An alternative configuration of pivot assembly 860 is shown in FIG. 19D.In this configuration, the portions of the lower peripheral portion 861Bof support flange 861 to which the lower ends of the primary loadsupport 862 and the actuators 863A, 863B, and 863C are attached areconfigured as discrete lateral projections from the side portion 8610 ofthe support flange 861. FIG. 18D also illustrates a possible arrangementof drive motors 865A, 865B and 865C for the respective actuators 863A,863B and 863C.

As described above with respect to FIGS. 9C and 91 ), one or morerobotic arms can be coupled to the table to reach a desired treatmenttarget on a patient disposed on the table top. In a robotically assistedsurgical procedure, the robotic arm(s) can be disposed in a desiredoperative position relative to a patient disposed on the table top ofthe surgical table. In some embodiments, a table top can be coupled tothe column via, a table top adapter coupling. FIGS. 20A and 20Billustrate such an embodiment. In this embodiment, the surgical table900 can be the same as or similar in structure and function to any ofthe surgical tables described herein. Thus, some details regarding thesurgical table 900 are not described below. It should be understood thatfor features and functions not specifically discussed, those featuresand functions can be the same as or similar to any of the surgicaltables described herein.

In this embodiment, the surgical table 900 includes a table top 920, atable support or column 922, a table base 950, a pivot assembly 960, atable top adapter coupling 975 (also referred to herein as “table topadapter”) disposed between and arranged to couple the column 922 and thetable top 920, and two robotic arms 930 coupled to the table top adaptercoupling 975. The pivot assembly 960 is operably coupled to the tabletop adapter 975 and can enable pivoting (as discussed with respect toprevious embodiments) of the table top adapter 975 and in turn the tabletop 920 to place the table top 920 in a desirable position andorientation for a given procedure.

In this embodiment, the robotic arms 930 are coupled to and extend fromthe table top adapter 975. Coupling the robotic arms 930 to the tabletop adapter 975 in this manner, however, may have some drawbacks. Forexample, in such an embodiment, tilt of the table top 920 and/or itsconstituent sections will cause movement or tilt of the robotic arms 930because the robotic arms 930 are coupled to the table top 920 via thetable top adapter 975, as illustrated schematically in FIG. 20B. Assuch, positioning of the robotic arms 930 (and any instruments attachedthereto) needs to incorporate table top 920 positioning, therebycomplicating the operation of the system. As another example of apotential drawback, coupling both the table top 920 and the robotic arms930 to the table top adapter 975 may result in the table top 920 and therobotic arms 930 having too similar of modal frequencies, therebypotentially increasing unwanted vibration at the working ends, asdescribed in more detail herein.

Such drawbacks can be addressed, for example, by coupling the roboticarms to a more rigid structure of the surgical table and to a structureindependent from tilting motions of the table top and/or its constituentsections. Such an embodiment is illustrated schematically in FIGS.21A-21E. In this embodiment, the surgical table 1000 can be the same asor similar in structure and function to any of the surgical tablesdescribed herein. Thus, some details regarding the surgical table 1000are not described below. It should be understood that for features andfunctions not specifically discussed, those features and functions canbe the same as or similar to any of the surgical tables describedherein.

In this embodiment, the surgical table 1000 includes a table top 1020, atable base 1050, a table support or column 1022 located at or near thecenter of the table base 1050, a pivot assembly 1060 disposed on top ofthe column 1022, two robotic arms 1031, 1032, and a table top adaptercoupling 1075 (also referred to herein as “table top adapter”) disposedbetween and arranged to couple the column 1022 and the table top 1020.The table top adapter 1075 is operably coupled to the pivot assembly1060 and the table top 1050. The column 1022 includes two sections thattelescope relative to each other to provide translation in the Z axis(eight above the floor).

As shown, the pivot assembly 1060 is disposed on top of and coupled tothe top of the column 1022, and is further coupled to the bottom of thetable top adapter 1075. In this manner, the column 1022 and the pivotassembly 1060 can translate simultaneously in the Z axis (height abovethe floor), and the table top 1020 can be disposed at a suitable heightabove the floor. The pivot assembly 1060 includes a primary load support1062, a first actuator 1063A, a second actuator 1063B, a third actuator1063C, and a support flange 1061 arranged to support the pivot assembly1060 and to couple the pivot assembly 1060 with the column 1022, asillustrated schematically in FIGS. 21A-21C.

In this embodiment, the primary load support 1062 is disposed on top ofthe column 1022. More specifically, the lower end of the primary loadsupport 1062 is disposed within the periphery of the support column 1022in a plane transverse to the vertical axis (Z axis) of the column 1022,i.e., in the X-Y plane. The upper end of the primary load support 1062includes a pivot 1064 (e.g., a gimbal joint) operably coupled to thelower side of the table top adapter 1075. Disposing the primary loadsupport 1062 on top of the column 1022 in this manner allows the centerof gravity (CG) of the load carried by the column 1022 (i.e., the tabletop, the robotic arms, the patient, and any other equipment mounted tothe table top or support column) to be placed at or near the center ofthe column 1022, thereby limiting or reducing uneven loading at thetelescoping column 1022, improving stiffness and stability of thesystem, and increasing modal frequency of the table top 1020 and thecolumn 1022. In this embodiment, the center of gravity (CG) and thecenter of the column 1022 is also placed at or near the origin of thebase's 1050 X axis and Y axis. Further, disposing the primary loadsupport 1063 on top of the column 1022 and distributing the actuators1063A, 1063B, 1063C about the primary load support 1063 reduces and/oreliminates the undesirable bending moment and shear force describedabove with respect to FIGS. 17A-17C, thereby limiting or reducing unevenloading at the telescoping column 1022, improving stiffness andstability of the system, and increasing modal frequency of the table top1020 and the column 1022.

Similarly as described with respect to the embodiment of FIG. 19D, inthis embodiment, the support flange 1061 includes an upper portion 1061Acoupled to the top of the support column 1022, a lower peripheralportion 1061B, and a side portion 1061C connecting the lower peripheralportion 1061B to the upper portion 1061A. The lower end of the primaryload support 1062 is coupled to the upper portion 1061A of the supportflange 1061, and the lower ends of the actuators 1063A, 1063B, and 1063Care coupled to the lower peripheral portion 1061B.

In this embodiment, with the primary load support 1062 connected at itslower end to the support flange 1061, and the pivot 1064 (e.g., a gimbaljoint) of the primary load support 1062 is operably coupled to the lowerside of the table top adapter 1075, as described above, the actuatorsare distributed about the periphery of the column 1022 and the primaryload support 1062 (similar to the embodiment of FIG. 19B). Morespecifically, the first actuator 1063 is connected at its lower end tothe lower peripheral portion 1061B, on one side of the column 1022. Thethird actuator 1063C is connected at its lower end to another portion ofthe lower peripheral portion 1061B of the support flange 1061, on a sideof the column 1022 opposite to the portion of the support flange 1061 towhich the lower end of the first actuator 1063A is connected. Further,the second actuator 1063B is connected at its lower end to the lowerperipheral portion 1061B of the support flange 1061 at a third portionof the lower peripheral portion 1061B on a side of the column 1022between the first and second portions of the support flange 1061 alongthe Y axis, and such that the primary load support 862 is disposedbetween the first/second portions and the third portion of the supportflange 1061 along the X axis. Each of the actuators 1063A, 1063B, and1063C is coupled at its upper end (e.g., with a gimbal joint) to thelower side of the table top adapter 1075.

Further, as shown, in this embodiment, the robotic arms 1031, 1032 arecoupled to the support flange 1061 of the pivot assembly 1060 (ratherthan being coupled to the table top adapter or the table top). In thismanner, in use, the robotic arms 1031, 1032 can translate simultaneouslywith the column 1022, the table top 1020, and the table top adapter 1075in the Z axis (height above the floor), but are independent from anypivoting or tilting of the table top 1020 and table top adapter 1075.This feature is illustrated schematically in FIG. 21C in which the pivotassembly 1050 is adjusted such that the table top 1020 and the table topadapter 1075 are tilted, while the robotic arms 1031, 1032 remain in avertical position (i.e., the same vertical position the robotic arms1031, 1032 were in prior to the pivot assembly being adjusted, asillustrated schematically in FIG. 21A).

An alternative configuration of surgical table 1000 is shown in FIGS.21D and 21E. In this configuration, four robotic arms 1031, 1032, 1033,and 1034 are shown coupled to the table top adapter 1075. FIG. 21E alsoillustrates a possible arrangement of drive motors 1065A, 106513 and1065C for the respective actuators 1063A, 1063B and 1063C.

Coupling the robotic arms to the support flange 1061 in this mannerincreases desirable modal frequency separation and reduces crosstalkvibration between the robotic arms and between the robotic arms and thetable structure(s) to which the robotic arms are coupled. Even more, asthe support flange 1061 and the column 1022 to which the support flange1061 is coupled are stiffer and more stable than the table top 1020 andthe table top adapter 1075 (i.e., the support flange 1061 and the column1022 have a higher modal frequency), coupling the robotic arms to thesupport flange 1061 improves stiffness and stability of the system, andcan reduce undesirable vibrations at the distal ends of the roboticarms.

To further stiffen the surgical table and increase its modal frequencyand thus reduce undesirable vibrations at the distal ends of roboticarms attached thereto, any of the embodiments described herein caninclude telescoping and lockable support struts. FIGS. 22A and 22Billustrate such an embodiment. In this embodiment, for ease ofdescription, as illustrated, the surgical table 1100 is shown with onlya table top 1120, a table base 1150, a table support or column 1122, andthree support struts 1178. The surgical table 1100, however, can be thesame as or similar in structure and function to any of the surgicaltables described herein. Thus, some details regarding the surgical table1100 are not described below. It should be understood that for featuresand functions not specifically discussed, those features and functionscan be the same as or similar to any of the surgical tables describedherein.

The support struts 1178 are disposed between and coupled to the tabletop 1120 and the table base 1150, and include an upper section 1178A anda lower section 1178B that telescope relative to each other to providetranslation in the Z axis (height above the floor). In this manner, thesupport struts 1178 can translate simultaneously with the column 1122and the table top 1120 along the Z axis to place the table top 1120 at asuitable height above the floor. Each support strut 1178 includes apivot joint (which may be, for example, a gimbal join) at each of itsupper and lower ends to allow pivotal or rotational movement of thetable top 1120 relative to the support struts 1178 and the column 1122.Each support strut 1178 is lockable, i.e. the telescoping sections canbe selectively fixed to each other so that they cannot telescope. Inthis manner, in use, once the table top 1122 is placed in a desiredposition above the floor and in a desired orientation (e.g., a desiredtilt), the support struts 1178 can be locked. Locking the support struts1178 provides greater structural resistance to movement of the table toprelative to the base and thus can increase the modal frequency of tablestructures (e.g., the table top 1122) to which the robotic arms (notshown) are coupled. In particularly, the support struts 1178 can limitand/or reduce potential sway of the table top 1178, e.g., as discussedwith respect to FIGS. 15A and 15B.

In an alternative embodiment, rather than coupling one or more supportstruts between the table top and directly to the table base, one or moresupport struts can have an upper end coupled to the table top and alower end coupled to the column (e.g., an upper end of the column).

The support struts 1178 can be lockable in any suitable manner. In thisembodiment, the support struts 1178 include a brake 1179, as illustratedschematically in cross-section in FIGS. 23A and 23B. As shown, the brake1179 is disposed between the telescoping sections of the support struts1178 can be extended from a first position (FIG. 23A), in which thesections of the support struts 1178 are “free following” or otherwiseallowed to telescope relative to one another along the Z axis, to asecond, engaged position (FIG. 23B) in which the telescoping sectionsare locked and thus prevented from telescoping relative to one anotheralong the Z axis.

In other embodiments, in addition to or instead of brakes, supportstruts can include lockable bearings to lock the support struts suchthat the sections of the support struts cannot telescope relative to oneanother.

Although in this embodiment the support struts 1178 are shown anddescribed as being located outside of the column 1122, in otherembodiments, one or more support struts can be disposed inside of thecolumn.

Further, although in this embodiment the surgical table 1100 includesthree support struts, in other embodiments, a surgical table can includeany suitable number of support struts (e.g., one support strut, twosupport struts, four support struts, or more).

In other embodiments, any or all of the support struts 1178 can includemore than two sections that telescope relative to each other. In suchembodiments, a locking mechanism is provided to selectively lock eachsection relative to the adjacent section.

As described above, it is desirable to reduce unwanted vibration at theworking ends of the robotic arms of a robotic surgical system. Roboticsurgical systems can include robotic surgical arms that are coupled to asurgical table via an adapter on which a patient can be supported duringa surgical procedure. The robotic surgical arms may support at theirdistal, working ends various devices, including surgical instruments,cannulae for providing access to the patient's body cavity(ies) andorgans) for application of surgical instruments, imaging devices,lights, etc. In such systems, it is desirable to establish and maintainhigh positional accuracy for the devices mounted on the distal ends ofthe robotic arms.

Positional accuracy can be reduced or degraded by vibration of thedistal ends of the robotic arms. Such vibration may be in the form ofvibrational cross-talk, which is unwanted vibration occurring in onepart of the system that originates in another part of the system. Forexample, vibration may be induced within a robotic arm, such as byoperation of a motor driving movement of some portion of the armrelative to another portion of the arm and/or to the surgical table orother supporting structure, and the energy introduced into the arm byoperation of the motor may propagate through the arm to the distal end,inducing vibration in the distal end. This arm may be referred to as the“active” arm. Alternatively, or additionally, energy introduced into theactive arm, such as by operation of a motor within the active arm, maypropagate through the active arm, through the table or other supportingstructure, and through another robotic arm (which may be referred to asthe “passive” arm) to the passive arm's distal end. It is desirable toreduce vibrational cross-talk to enhance positional accuracy of thedistal ends of robotic arms and the devices attached thereto.

To address vibrational cross-talk and positional accuracy of the distalends of robotic arms and the devices attached thereto, apparatus andmethods for providing a robotic surgical system including roboticsurgical arms that are coupled to a surgical table via an adapter onwhich a patient can be supported during a surgical procedure are variousembodiments described herein with respect to FIGS. 24A-30B.

Apparatus and methods for providing a robotic surgical system includinga surgical table having a tabletop on which a patient can be disposedare described herein. In some embodiments, an apparatus includes asurgical table and robotic arms coupled, or coupleable to, the surgicaltable, with each robotic arm supporting a medical instrument, such as asurgical tool, tool driver, cannula, light, and/or imaging device. Thesurgical table includes a base, a pedestal or column, and a tabletopcoupled to the column. Each of the robotic arms may be coupled to atleast one of the tabletop, the column or the base. Each robotic armprovides two or more links between the proximal end of the arm (at whichthe arm is coupled to the table) and the distal end of the arm (at whichthe arm is coupled to the medical instrument). The links are coupled toeach other, and may be coupled to the table and to the medicalinstrument, by a joint that provides one or more degrees of freedom ofrelative movement between the links coupled by the joint, andcorrespondingly one or more degrees of freedom of relative movementbetween the distal end of the robotic arm and the surgical table. Thelinks and corresponding degrees of freedom allow for movement of thedistal end of the robotic arm about and/or along the X, Y. and/or Zaxes, to a desired location relative to the tabletop and/or a patientdisposed thereon and/or a desired target portion of the anatomy of apatient disposed thereon. Relative movement of the links about thejoints can be initiated and continued by operation of devices such asmotors, and/or resisted or stopped by active devices such as motorsand/or passive devices such as brakes. As noted above, such devices canintroduce energy into the robotic surgical system, which can produceunwanted vibrations at the distal ends of the robotic arms.

In some embodiments, an apparatus includes a surgical table having apatient tabletop, an adapter coupled to the surgical table, and one ormore robotic arms coupled to the adapter. In some embodiments, anapparatus can include a surgical table having a patient tabletop and anadapter/robotic arm assembly coupled to the surgical table. For example,the adapter and robotic arm can be an integral mechanism or component.Each of the adapter and the robotic arms, or an adapter/robotic armassembly, can include one or more links to allow for movement of theadapter and/or arms about and/or along the X, Y, and/or Z axes, to adesired location relative to the tabletop and/or a patient disposedthereon and/or a desired target portion of the anatomy of a patientdisposed thereon.

In some embodiments, an apparatus includes an adapter coupleable to, andsupportable by, a surgical table below a tabletop of the surgical table.The surgical table has a support coupled to the tabletop and a basecoupled to the support. As discussed in more detail herein the adapteris designed to reduce vibrational cross-talk to enhance positionalaccuracy of the distal ends of the robotic arms and devices attachedthereto. To this end, the adapter has at least two sections, including afirst section configured to be coupled to a proximal end portion of afirst robotic arm and a second section configured to be coupled to aproximal end portion of a second robotic arm. The first section has afirst stiffness and the second section has a second stiffness that isgreater than the first stiffness. In this manner, the first section withthe first stiffness will have a first resonant or modal frequency, andthe second section with the second stiffness will have a second resonantor modal frequency different from the first resonant frequency. Varyingthe resonant frequencies across the adapter can reduce vibrationalcross-talk to/from the robotic arms attached to the adapter.

In some embodiments, an adapter, in addition to or instead of havingmultiple sections with varying stiffness, can define a gap between thefirst section and the second section. In such embodiments, the apparatusmay further include a damper disposed within the gap of the adapter toabsorb crosstalk vibration between the robotic arms attached to theadapter. In alternative embodiments, instead of a damper disposed withinthe gap, an apparatus can include a spring-damper assembly disposedwithin the gap of the adapter to absorb crosstalk vibration between therobotic arms attached to the adapter.

As shown schematically in FIGS. 24A-24B, a surgical table 1200 includesa tabletop 1220, a table support or column 1222 and a table base 1224.The tabletop 1220 has an upper surface on which a patient can bedisposed during a surgical procedure, as shown schematically in FIG.24A. The tabletop 1220 is disposed on the column 1222, which can be, forexample, a pedestal, at a suitable height above the floor. The column1222 may provide for movement of the tabletop 1220 in a desired numberof degrees of freedom. For example, as illustrated schematically in FIG.24A, the column 1222 may have two sections that telescope relative toeach other to provide translation in the Z axis (height above thefloor). Additionally, or alternatively, the tabletop 1220 may be movablerelative to the base 1250 along the Y axis (along the longitudinal axisof the table), and/or the X axis (along the lateral axis of the table),and/or about the Z, Y, and/or X axis. The tabletop 1220 may also includemultiple sections that are movable relative to each other along/aboutany suitable axes, e.g., separate sections for each of the torso, one orboth legs, and/or one or both arms, and a head support section. Movementof the tabletop 1220 and/or its constituent sections may be performedmanually, driven by motors, controlled remotely, etc. The column 1222for the tabletop may be mounted to the base 1224, which can be fixed tothe floor of the operating room, or can be movable relative to thefloor, e.g., by use of wheels on the base. As shown schematically inFIG. 24A, in some embodiments, the height of the column 1222 can beadjusted, which together with, for example, the motion (e.g., axial(longitudinal) or lateral motion) of the tabletop 1220, can allow forthe tabletop 1220 to be positioned at a desired surgical site at acertain height above the floor (e.g., to allow surgeon access) and acertain distance from the column 1220. This also can allow robotic arms1230 coupled to the table 1200 to reach a desired treatment target on apatient disposed on the tabletop 1220.

In a robotically assisted surgical procedure, one or more robotic arms1230 can be disposed in a desired operative position relative to apatient disposed on the tabletop 1220 of the surgical table 1200 (alsoreferred to herein as “table”), as shown schematically in FIGS. 24C and24D. The robotic arm(s) can be used to perform a surgical procedure on apatient disposed on the surgical table 1200. In particular, the distalend of each robotic arm can be disposed in a desired operative positionso that a medical instrument coupled to the distal end of the roboticarm can perform a desired function.

In accordance with various embodiments, the connection between thesurgical table and the proximal end of each robotic arm (and thus theposition and orientation of the medical instrument at the distal end ofthe robotic arm relative to the patient), is implemented with an adapter1228 and robotic arms) 1230 coupled to the adapter 1228. The adapter1228 can be separate from, but engaged with, or coupleable to, thesurgical table 1200, or can be fixedly attached to the surgical table1200. The adapter 1228 can be coupled to, for example, the support 1222,the table base 1224, and/or the tabletop 1220 of the table 1200. Asshown schematically in FIGS. 24C and 24D, the adapter 1228 is disposedbelow the tabletop 1220 of the surgical table 1200.

In use, the robotic arms 1230 can be moved relative to the tabletop 1220and/or a specific target treatment location on the patient. In someembodiments, the axial motion (e.g., in the Y-axis direction) of thetabletop 1220 can assist in allowing the arms 1230 (and therefore, themedical instrument or tool coupled to the distal end of the arm) toreach the desired anatomy on the patient or provide clearance for accessto the patient as needed. In some embodiments, the combination ofvertical movement of the column 1222, axial movement of the tabletop1220 and movement of, for example, links in the robotic arm 1230 allowthe robotic arm to be placed in a position where it can reach theanatomy of the patient at the required height over the floor.

As shown schematically in FIGS. 25A and 25B, each robotic arm 1230 caninclude a distal end portion 1237 and a proximal end portion 1236. Thedistal end portion 1237 (also referred to herein as “operating end”) caninclude or have coupled thereto a medical instrument or tool 1215. Theproximal end portion 1236 (also referred to herein as the “mounting endportion” or “mounting end”) can include the coupling portion to allowthe robotic arm 1230 to be coupled to the tabletop 1220 of the table1200. The robotic arm 1230 can include two or more link members orsegments 1210 coupled together at joints that can provide fortranslation along and/or rotation about one or more of the X, Y and/or Zaxes. The coupling portion of the robotic arm 1230 to couple the roboticarm 1230 to the tabletop 1222 at the coupling 1218 can be disposed atthe distal or mounting end 1236 of the arm 1230 and may be coupled to asegment 1210 or incorporated within a segment 1210. The robotic arm 1230also includes a target joint J1 disposed at or near the mounting end1236 of the robotic arm 1230 that can be included within the couplingportion of the coupling 1218 or disposed on a link or segment 1210 ofthe robotic arm 1230 coupled to the coupling portion. The target jointJ1 can provide a pivot joint to allow a distal segment of the roboticarm 1230 to pivot relative to the tabletop 1220. The robotic arm 1230can be moved between various extended configurations for use during asurgical procedure, as shown in FIG. 25A, and various folded orcollapsed configurations for storage when not in use, as shown in FIG.25B.

As described with respect to FIGS. 24C and 241 ), the adapter 1228 canbe coupled to, for example, the column 1222, the table base 1224 and/orthe tabletop 1220 of the table 1200. However, the distinction between anadapter and robotic arm can be disregarded, and the connection betweenthe surgical table and the distal end of the robotic arm can beconceptualized and implemented as a series of links and joints thatprovide the desired degrees of freedom for movement of the medicalinstrument, i.e. at the distal end of the connection. The connection mayinclude a releasable coupling at any one or more link(s) or joint(s) orany location along the series of links and joints.

As described herein, in some embodiments, the various sections of thetabletop 1220 can move relative to each other (e.g., can be tilted orangled relative to each other) and/or the tabletop 1220 can be moved(e.g., tilted, angled) relative to the column 1222 and/or the base 1224of the surgical table 1200. In some embodiments, it is contemplated thatthe adapter 1228 and robotic arms 1230 coupled thereto can move with thetorso section of the tabletop 1220 such that the frame of reference tothe X, Y and Z axes for various embodiments remains relative to the topsurface of the tabletop 1220. In some embodiments, the adapter 1228 androbotic arms 1230 can be coupled to the support pedestal 1222 of thetable 1200 and when the tabletop 1220 is moved relative to the support1222, the positioning of the adapter 1228 and arms 1230 can becoordinated with the movement of the tabletop 1220.

In accordance with various embodiments, each robotic arm 1230 may bepermanently, semi-permanently, or releasably coupled to the adapter 1228via the coupling 1218. The coupling 1218 can include a variety ofdifferent coupling mechanisms, including a coupling portion (not shown)on the adapter 1228 that can be matingly coupled to a coupling portion(not shown) on the robotic arm. Each robotic arm 1230 can be coupled ata fixed location on the table 1200 or can be coupled such that therobotic arm 1230 can be movable to multiple locations relative to thetabletop 1220 and/or a patient disposed on the tabletop 1220 asdescribed in more detail herein. For example, the robotic arm 1230 canbe moved relative to the tabletop 1220 and/or a specific targettreatment location on the patient. In some embodiments, the axial motion(e.g., in the Y-axis direction) of the tabletop 1220 can assist inallowing the arms 1230 (and therefore, the medical instrument or toolcoupled to the distal end of the arm) to reach the desired anatomy onthe patient or provide clearance for access to the patient as needed. Insome embodiments, the combination of vertical movement of the supportpedestal 1222, axial movement of the tabletop 1220 and movement of, forexample, one or more link members, allows for placement of the roboticarms 1230 in a position where it can reach the anatomy of the patient atthe required height over the floor.

Some structural requirements for the adapter 1228 can include providinga rigid support of the robotic arm 1230 while maintaining adjustabilityfor pre-operative and intra-operative position changes of the roboticarm 1230. In some embodiments, the table adapter 1228 can include ameans of holding or locking the adapter 1228 at a fixed position towithstand, for example, the effects of gravity, inertial effects due torobotic arm motion, and/or to withstand accidental bumps from a user oranother part of the robotic system (including other robotic arms ortable motion). The table adapter 1228 can also include one or moresensors for measuring the spatial position of the adapter 1228 and/orangles and displacements of various joints and coupling points of theadapter 1228.

The various degrees of freedom of the links of the adapter 1228 and/orrobotic arm 1230 provide for movement of the robotic arm 1230 andtherefore, a medical instrument 1215 disposed at a distal end thereof tobe moved to a variety of different positions and orientations relativeto the tabletop 1220 to perform various different procedures on apatient disposed thereon. The adapters 1228 described herein can alsoprovide for variations on the number of robotic arms 1230 that arecoupled to the table to use for a particular procedure, and to positionrobotic arms 1230 on one or both sides of the tabletop 1220. Forexample, in some procedures, it may be desirable to position two roboticarms 1230 on one side of the tabletop 1220 and two robotic arms 1230 onan opposite side of the tabletop 1220. In other procedures, it may bedesirable to position three robotic arms 1230 on one side of thetabletop 1220 and one robotic arm 1230 on an opposite side of thetabletop 1220. It should be understood that the number of robotic arms1230 to be used for a particular surgery can vary.

As shown schematically in FIG. 26 , an energy source ES, such as motorat a joint between two links in active arm 1230, in use, can induceunwanted vibration V1 in tool 1215 of active arm 1230, and/or vibrationV2 in tool 1215′ of passive arm 1230′ via interface structure(s) 1240and column 1222. For example, energy introduced by the energy source ESin the active arm 1230 may propagate through the active arm 1230,through the interface structure(s) 1240 and column 1222, and through thepassive arm 1230′ to the tool 1215′ of the passive arm 1230′, inducingvibration V2 in tool 1215′. It is desirable to reduce such vibrationalcross-talk from energy source ES of active arm 1230 to tool 1215 ofactive arm 1230 and to tool 1215 of passive arm 1230′ to enhancepositional accuracy of the tool 1215 of active arm 1230 and tool 1215′of passive arm. In some instances, various components along/about eachof three axes of the system may be subject to varying vibrations. Insuch instances, it is desirable to reduce amplitude of at least the mostcritical components, if not all of the components, to enhance positionalaccuracy of the distal ends of the robotic arms and the devices attachedthereto.

FIGS. 27A-28B illustrate various embodiments of apparatus and methodsfor reducing vibrational cross-talk by separation the modal frequenciesof vibration across various sections of the table structure(s) (e.g., atable adapter) to which the robotic arms are coupled, and/or byisolating at least in part the connection points of the tablestructure(s) to which the robotic arms are coupled.

To limit vibrational cross-talk across an adapter to which robotic armsare coupled, in some embodiments, an adapter can have multiple sectionsin which one section has a modal frequency of vibration different from amodal frequency of vibration of one or more of the remaining sections.Decoupling the modal frequencies of the sections of the adapter reducesthe efficiency of transmission of the energy introduced into the activearm. For example, if an active robotic arm has a mode of 4 Hertz (Hz),energy introduced into the active robotic arm is best transferred acrossthe adapter to another robotic arm (e.g., a passive robotic arm) whenthe adapter has a, mode equal to the mode of the active robotic arm; inthis case, a mode of 4 Hz. Transmission of the energy across the adaptercan be lessened and/or interrupted by arranging the adapter to havevarying modal frequencies of vibration, thereby creating modalseparation between one connection point of the adapter to anotherconnection point of the adapter. Less energy transmitted between theconnection points (and thereby the robotic arms coupled to theconnection points) results in less vibration produced, e.g., at thepassive arm.

To vary the modal frequency of an adapter to interrupt energy transferacross the adapter, in some embodiments, an adapter can have multiplesections each having a characteristic different from a characteristic ofat least one other section of the adapter, the differentcharacteristic(s) resulting in a different modal frequency for eachsection. A characteristic, for example, can include dimensions (e.g.,width, height, and/or length) and/or geometry, such as the presence ofabsences of ribs, flanges, or other configurations that affect themoment of inertia about the axis or axes of interest for response tovibration. Thus, the table adapter can be monolithically or integrallyformed of a single material but each section can be formed withdifferent dimensions and/or geometries. Alternatively, or in addition,the multiple sections can be formed of one or more different materials,or combinations of materials, that have different physical properties,such as modulus of elasticity, density, and the like.

As an example, FIGS. 27A and 27B illustrate an adapter 1328 having afirst section 1328A with a first thickness t1 and a second section 1328Bwith a second thickness t2 less than the first thickness, according toan embodiment. In this manner, the first section 1328A has a modedifferent from a mode of the second section 1328B, thereby lesseningenergy transfer from one robotic arm 130, across both the first section1328A and second section 1328B, to another robotic arm 130. In thisexample, adapter 1328 may be monolithically or integrally formed from asingle material. Alternatively, adapter 1328 may be assembled frommultiple pieces, e.g. first section 1328A and second section 1328B maybe integrally formed of a material of thickness t2, and a separate pieceof the same material may be fixed to first section 1328A to increase thethickness to t1, as illustrated in FIG. 27C. Alternatively, one or moreof the sections 1328A and 138813 may be formed of a composite orlaminate of different materials with different physical properties

In alternative configurations, instead of or in addition to the firstsection and the second sections having different thicknesses, the firstsection can have any characteristic(s) affecting its mode different fromone or more characteristics of the second section affecting the mode ofthe second section. For example, in some embodiments, the first sectionof the adapter can be shaped or configured to have a first moment ofinertia or stiffness, and the second section of the adapter can beshaped or configured to have a second moment of inertia or stiffnessdifferent from the first stiffness. In this manner, the first section ofthe adapter can be configured to have a higher mode than the mode of thesecond section, thereby reducing efficiency of energy transmissionbetween the first and second sections. Such an example is illustrated inFIGS. 27D and 27E in which the first section 1328A of the adapter 1328includes a set of ribs 1327. In this manner, first section 1328A withthe ribs 1327 has a moment of inertia different from a moment of inertiaof the second section 1328B. The ribs 1327 can be monolithically formedor integral to the first section 1328, or the ribs 1327 can be formedseparately and then coupled to the first section 1328, or a combinationof the two. Further, although this embodiment includes three ribs, inalternative embodiments, any suitable number of ribs (e.g., 1, 2, 4 ormore) can be used, and the ribs can be of the same or varying sizes andshapes. Moreover, although the adapters described herein having twosections, in alternative embodiments, an adapter can have any suitablenumber of sections (e.g., 3, 4, 5, 6 or more), each to support adifferent robotic arm, with any variation of modal frequencies such thatundesirable vibrational cross-talk is reduced or otherwise limited.

An additional or alternative approach to reducing vibrational cross-talkcan include decoupling in part (e.g., limit direct coupling) theconnection points of the adapter to which the robotic arms are coupled.Isolating the connection points to which the robotic arms are coupled orotherwise interrupting energy transfer pathways (e.g., via separation,dampening, varying materials and dimensions, and the like) between thoseconnection points reduces the efficiency of transmission of the energyintroduced into the active arm by, for example a motor and/or brake. Forexample, energy introduced into the active robotic arm is besttransferred to a passive robotic arm when the intervening structure(e.g., a table adapter) to which the two arms are mounted presentsminimal obstacles to energy transfer (e.g., via a direct coupling).Transmission of the energy introduced into the active robotic arm acrossthe intervening structure can be lessened and/or interrupted by variousmeans discussed below, thereby complicating the pathway energy wouldneed to transfer to reach the connection points, thereby reducing theefficiency of energy transmission to the passive arm. Less energytransmitted between arms results in less vibration produced, i.e. loweramplitude in/about one or more axes.

FIGS. 28A and 28B illustrate such an embodiment whereby the connectionspoints of an adapter 1428 are isolated in part from each other. Asshown, the adapter 1428 includes a first section 1428A, a second section1428B, a third section 1428C, a fourth section 1428D (also referred toherein collectively as the “sections of the adapter”), with robotic armscoupleable to a connection portion of the first section 1428A, thesecond section 1428B, and the third section 1428C. Further, asillustrated, the adapter defines a set of gaps 1429 between the sectionsof the adapter 1428. In this manner, the gaps 1429 provide partialseparation/decoupling of the sections of the adapter 1428 to each other,resulting in less efficient transmission of energy across the adapter,e.g., from a connection point to which an active robotic arm is coupledto a connection points to which a passive robotic arm is coupled. Inother words, the vibrational energy must travel through the centralportion of adapter 1428, which may be coupled to the tabletop and/or thetable column (not shown) and thus has a relatively higher stiffness andmodal frequency than that of either of the adapter sections.

In some embodiments, one or more (e.g., including all) of the gapsbetween sections of an adapter can include a damping componentconfigured to absorb or otherwise dissipate energy introduced into theadapter at its connection points to which the robotic arms are coupled,thereby reducing or otherwise limiting vibrational cross-talk in thesystem. One such embodiment is shown in FIGS. 29A-29C. As shown, theadapter 1528 includes a first section 1528A, a second section 1528B, athird section 1528C, and a fourth section 1528, with gaps 1529 definedtherebetween. Further, disposed within each gap 1529 is a dampingcomponent 1531. Each of the damping components 1531, for example, caninclude at least one viscoelastic material (e.g., a viscoelasticpolymer) or otherwise any material that exhibits both viscous andelastic characteristics when undergoing deformation, and is suitable forisolating vibration, dampening noise, and/or absorbing shock. Somenon-limiting examples of viscoelastic materials include urethanepolymers such as Sorbothane® (Sorbothane, Inc.), vulcanized cross-linkedrubber material such as Akton® (Action Products, Inc.), hydrophobicmelamine foams such as Polydamp® (Polymer Technologies, Inc.), andviscous damping gels such as NyeMed® (Nye Lubricants, Inc.). The dampingbetween any two adjacent sections, i.e. across one of the gaps 1529, canbe varied by varying the material and/or the dimensions of the material,i.e. the width of the gap and/or the portion of the length and orvertical extent of the gap filled by the material.

In another embodiment, one or more of the gaps in the adapter can havedisposed therein a damper assembly. As shown schematically in FIGS. 30Aand 30B, damper assembly 1632 can be coupled to adjacent sections 1628A,1628B of adapter 1628, across gap 1629 (and similarly to adjacentsections 1628A, 1628C, adjacent sections 1628C, 1628D, and adjacentsections 1628B, 1628D). Damper assembly 1632 can include a damper, shownschematically in FIGS. 30A and 30B as dashpot, which provides aresistance to relative movement of sections 1628A, 1628B that isproportional to the velocity of the relative movement. This may beimplemented as a hydraulic or pneumatic damper, in which a fluid isforced through an orifice by relative movement of sections 1628A, 1628B.As shown schematically in FIGS. 30A and 30B, damper assembly 1632 mayalso include a structure that functions as a spring, i.e. produces aforce that is proportion to the relative displacement between sections1628A, 1628B. The damping and spring coefficients for damper assembly1632 may be selected to provide the desired response function to reducethe transfer of energy across gap 1629.

Any suitable combination of damping components can be used to dampenenergy otherwise being transferred across sections of the adapter,thereby limiting and/or reducing undesirable vibrational cross-talk inthe system. Further, although adapters 1428 and 1528 are shown anddescribed as having four sections and four gaps, in alternativeembodiments, an adapter can have any suitable number of sections andgaps, and the sections and gaps can be similar or different in shape andsize to each other.

Although various embodiments have been described as having particularfeatures and/or combination of components, other embodiments arepossible having a combination of any features and/or components from anyof the embodiments described herein. For example, any of the bases e.g.,table base 150, 250, 350, 550, 650, 750, etc.) described herein can beused in combination with any of the supports (e.g., table support 122,support member 262, table support 1122, etc.), and/or adapters (e.g.,adapter 528, adapter coupling 975, adapter coupling 1075, etc.)described herein. Similarly stated, for ease of explanation someembodiments described herein focus on discrete features to addressparticular shortcomings of existing systems. It should be understood,however, that the discrete features described across various embodimentscan be combined into a single embodiment in any suitable combination.For example, in some embodiments, a surgical system may include a base(e.g., similar to base 250) configured to remedy undesirableconsequences associated with irregularities in a floor or other surfaceon which a surgical table is disposed and/or other undesirable loadimbalances (e.g., due to movement if equipment coupled to table and/ormovement of patient lying on table) during a surgical procedure; anadapter (e.g., adapter 528) configured to facilitate desired degrees offreedom for movement of a robotic arm coupled thereto and/or havingvarying sections of modal frequency or other features to inhibitvibrational cross-talk; and a pivot assembly (e.g. pivot assembly 660).

While various embodiments have been described above, it should beunderstood that they have been presented by way of example only, and notlimitation. Where methods described above indicate certain eventsoccurring in certain order, the ordering of certain events may bemodified. Additionally, certain of the events may be performedconcurrently in a parallel process when possible, as well as performedsequentially as described above.

As used herein the term “module” refers to any assembly and/or set ofoperatively-coupled electrical components that can include, for example,a memory, a processor, electrical traces, optical connectors, software(executing in hardware), and/or the like. For example, a module executedin the processor can be any combination of hardware-based module (e.g.,a field-programmable gate array (FPGA), an application specificintegrated circuit (ASIC), a digital signal processor (DSP)) and/orsoftware-based module (e.g., a module of computer code stored in memoryand/or executed at the processor) capable of performing one or morespecific functions associated with that module.

Some embodiments and/or methods described herein can be performed bysoftware (executed on hardware), hardware, or a combination thereof.Hardware modules may include, for example, a general-purpose processor,a field programmable gate array (FPGA), and/or an application specificintegrated circuit (ASIC). Software modules (executed on hardware) canbe expressed in a variety of software languages (e.g., computer code),including C, C++, Java™, Ruby, Visual Basic™ and/or otherobject-oriented, procedural, or other programming language anddevelopment tools. Examples of computer code include, but are notlimited to, micro-code or micro-instructions, machine instructions, suchas produced by a compiler, code used to produce a web service, and filescontaining higher-level instructions that are executed by a computerusing an interpreter. For example, embodiments may be implemented usingimperative programming languages (e.g., C, Fortran, etc.), functionalprogramming languages (Haskell, Erlang, etc.), logical programminglanguages (e.g., Prolog), object-oriented programming languages (e.g.,Java, C++, etc.) or other suitable programming languages and/ordevelopment tools. Additional examples of computer code include, but arenot limited to, control signals, encrypted code, and compressed code.

Where schematics and/or embodiments described above indicate certaincomponents arranged in certain orientations or positions, thearrangement of components may be modified. Similarly, where methodsand/or events described above indicate certain events and/or proceduresoccurring in certain order, the ordering of certain events and/orprocedures may be modified. While the embodiments have been particularlyshown and described, it will be understood that various changes in formand details may be made. Any portion of the apparatus and/or methodsdescribed herein may be combined in any combination, except mutuallyexclusive combinations. The embodiments described herein can includevarious combinations and/or sub-combinations of the functions,components and/or features of the different embodiments described.

The invention claimed is:
 1. A surgical table, comprising: a base; asupport column that extends upwardly from the base and having an upperend that has a periphery in a plane transverse to a vertical axis of thesupport column; a table top; a pivot assembly coupling the table top tothe upper end of the support column, the pivot assembly including: asupport flange attached to and disposed on top of the upper end of thesupport column and having a horizontal top surface that extends outsidethe periphery of the upper end of the support column; and a primary loadsupport, a first actuator, and a second actuator that are each mountedon the horizontal top surface, wherein the primary load support has anupper end having a pivot joint coupled to the table top, wherein thefirst actuator has an upper end having a pivot joint coupled to thetable top, and is variable in length in a vertical direction withrespect to the vertical axis to pivot the table top about the pivotjoint of the primary load support along at least a lateral pivot axiswith respect to the table top that runs through the pivot joint of theprimary load support, wherein the second actuator has an upper endhaving a pivot joint coupled to the table top, and is variable in lengthin the vertical direction to pivot the table top about the pivot jointof the primary load support along at least a longitudinal pivot axiswith respect to the table top that runs through the pivot joint of theprimary load support, wherein the first and second actuators maintain afixed vertical orientation with respect to the vertical axis while atleast one of the first and second actuators varies in length in thevertical direction, wherein the primary load support, the firstactuator, and the second actuator are arranged in a triangle on thehorizontal top surface such that each of the primary load support, thefirst actuator, and the second actuator are positioned at a vertex ofthe triangle, and wherein a first side of the triangle from the firstactuator to the primary load support extends along the longitudinalpivot axis and a second side of the triangle from the second actuatorand the primary load support extends along the lateral pivot axis. 2.The surgical table of claim 1, wherein the pivot assembly includes athird actuator that is mounted on the horizontal top surface, and has anupper end having a pivot joint coupled to the table top, the thirdactuator being variable in length in the vertical direction to pivot thetable top about the pivot joint of the primary load support along atleast the lateral pivot axis, wherein the third actuator maintains thefixed vertical orientation with respect to the vertical axis while atleast one of the first actuator, second actuator, and third actuatorvaries in length in the vertical direction.
 3. The surgical table ofclaim 2, wherein the primary load support, the first actuator, thesecond actuator, and the third actuator are arranged in a T-shape on thehorizontal top surface, and wherein a first portion of the T-shape thatextends along the longitudinal pivot axis includes the first actuator ata first end of the first portion, the third actuator at a second end ofthe first portion that is opposite to the first end of the firstportion, and the primary load support that is between the first andsecond actuators and in the middle of the first portion, and wherein asecond portion of the T-shape that extends along the lateral pivot axisfrom the primary load support at a first end of the second portion tothe third actuator at a second end of the second portion that isopposite to the first end of the second portion.
 4. The surgical tableof claim 1, wherein the pivot joint of the primary load support is agimbal joint.
 5. The surgical table of claim 1, wherein the lateralpivot axis and the longitudinal pivot axis are orthogonal and intersectone another at the pivot joint of the primary load support.
 6. Thesurgical table of claim 1, wherein each actuator includes a cylinderthat includes a bottom portion that is fixed to the horizontal topsurface and a movable piston, wherein the first and second actuatorsmaintain their respective fixed vertical orientations and pivot thetable top about the pivot joint of the primary load support as themovable piston of at least one of the first and second actuators extendaway from or retract towards the support flange in the verticaldirection.
 7. The surgical table of claim 1 further comprising a roboticarm coupled to the surgical table.
 8. The surgical table of claim 7further comprising a table top adapter that is disposed between 1) abottom side of the table top and 2) the upper end of the first actuatorand the upper end of the second actuator, wherein the robotic arm iscoupled to the surgical table via the table top adapter.
 9. The surgicaltable of claim 8, wherein the first and second actuators are arranged tocause the table top to perform a tilt motion about the pivot joint ofthe primary load support, wherein the robotic arm is arranged to performthe tilt motion in sync with the table top.
 10. A surgical table,comprising: a support column having an upper end that has a periphery ina plane transverse to a vertical axis of the support column; a tabletop; a pivot assembly coupling the table top to the support column, thepivot assembly including: a support flange fixedly coupled to anddisposed on top of the upper end of the support column and having ahorizontal top surface that extends outside the periphery of the upperend of the support column, a primary load support, a first actuator, anda second actuator that are each mounted on the horizontal top surface,wherein the primary load support has an upper end having a pivot jointcoupled to the table top, wherein the first actuator has an upper endhaving a pivot joint coupled to the table top, and is variable in lengthin a vertical direction with respect to the vertical axis to pivot thetable top about the pivot joint of the primary load support along atleast a lateral pivot axis with respect to the table top that runsthrough the pivot joint of the primary load support, wherein the secondactuator has an upper end having a pivot joint coupled to the table top,and is variable in length in the vertical direction to pivot the tabletop about the pivot joint of the primary load support along at least alongitudinal pivot axis with respect to the table top that runs throughthe pivot joint of the primary load support, wherein the first andsecond actuators maintain a fixed vertical orientation with respect tothe vertical axis while at least one of the first and second actuatorsvaries in length in the vertical direction, wherein the primary loadsupport, the first actuator, and the second actuator are arranged in atriangle on the horizontal top surface such that each of the primaryload support, the first actuator, and the second actuator are positionedat a vertex of the triangle, and wherein a first side of the trianglefrom the first actuator to the primary load support extends along thelongitudinal pivot axis and a second side of the triangle from thesecond actuator and the primary load support extends along the lateralpivot axis.
 11. The surgical table of claim 10, wherein the pivotassembly includes a third actuator that is mounted on the horizontal topsurface, and has an upper end having a pivot joint coupled to the tabletop, the third actuator being variable in length in the verticaldirection to pivot the table top about the pivot joint of the primaryload support along at least the lateral pivot axis, wherein the thirdactuator maintains the fixed vertical orientation with respect to thevertical axis while at least one of the first actuator, second actuator,and third actuator varies in length in the vertical direction.
 12. Thesurgical table of claim 10, further comprising a robotic arm coupled tothe surgical table.
 13. The surgical table of claim 12, furthercomprising a table top adapter that is disposed between 1) a bottom sideof the table top and 2) the upper end of the first actuator and theupper end of the second actuator, wherein the robotic arm is coupled tothe surgical table via the table top adapter.
 14. The surgical table ofclaim 13, wherein the first and second actuators are arranged to causethe table top to perform a tilt motion about the pivot joint of theprimary load support, wherein the robotic arm is arranged to perform thetilt motion in sync with the table top.
 15. The surgical table of claim10, wherein the pivot joint of the primary load support is a gimbaljoint.
 16. An apparatus, comprising: a pivot assembly that is coupled toa surgical table that has a table top, a support column, and a base, thepivot assembly coupling the table top to the support column that extendsupward from the base, the support column having an upper end that has aperiphery in a plane transverse to a vertical axis of the supportcolumn, the pivot assembly having: a support flange attached to anddisposed on top of the upper end of the support column and having ahorizontal top surface that extends outside the periphery of the upperend of the support column, and a primary load support, a first actuator,and a second actuator that are each mounted on the horizontal topsurface, wherein the primary load support has an upper end having apivot joint coupled to the table top, wherein the first actuator has anupper end having a pivot joint coupled to the table top, and is variablein length in a vertical direction with respect to the vertical axis topivot the table top about the pivot joint of the primary load supportalong at least a lateral pivot axis with respect to the table top thatruns through the pivot joint of the primary load support, wherein thesecond actuator has an upper end having a pivot joint coupled to thetable top, and is variable in length in the vertical direction to pivotthe table top about the pivot joint of the primary load support along atleast a longitudinal pivot axis with respect to the table top that runsthrough the pivot joint of the primary load support, wherein the firstand second actuators maintain a fixed vertical orientation with respectto the vertical axis while at least one of the first and secondactuators varies in length in the vertical direction, wherein theprimary load support, the first actuator, and the second actuator arearranged in a triangle on the horizontal top surface such that each ofthe primary load support, the first actuator, and the second actuatorare positioned at a vertex of the triangle, and wherein a first side ofthe triangle from the first actuator to the primary load support extendsalong the longitudinal pivot axis and a second side of the triangle fromthe second actuator and the primary load support extends along thelateral pivot axis.
 17. The apparatus of claim 16, wherein the pivotassembly includes a third actuator that is mounted on the horizontal topsurface, and has an upper end having a pivot joint coupled to the tabletop, the third actuator being variable in length in the verticaldirection to pivot the table top about the pivot joint of the primaryload support along at least the lateral pivot axis, wherein the thirdactuator maintains the fixed vertical orientation with respect to thevertical axis while at least one of the first actuator, second actuator,and third actuator varies in length in the vertical direction.
 18. Theapparatus of claim 16, wherein each actuator includes a cylinder that isfixed to the horizontal top surface and a movable piston, wherein thefirst and second actuators are arranged to pivot the table top about thepivot joint of the primary load support by having the movable piston ofat least one of the actuators extend away from the support flange in thevertical direction.
 19. The apparatus of claim 16, wherein the pivotjoint of the primary load support is a gimbal joint.
 20. The apparatusof claim 16, wherein the pivot assembly is coupled to the table top viaa table top adapter that includes at least one robotic arm.
 21. Theapparatus of claim 20, wherein the first and second actuators arearranged to cause the table top to perform a tilt motion about the pivotjoint of the primary load support, wherein the robotic arm is arrangedto perform the tilt motion in sync with the table top.